Provider Demographics
NPI:1275739328
Name:ZELONY, GARY DALE (CHIROPRACTOR)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:DALE
Last Name:ZELONY
Suffix:
Gender:M
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 N LILLEY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-3756
Mailing Address - Country:US
Mailing Address - Phone:734-981-0500
Mailing Address - Fax:
Practice Address - Street 1:3800 N LILLEY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3756
Practice Address - Country:US
Practice Address - Phone:734-981-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1718456Medicaid
MI950H25115Medicare UPIN
MI1718456Medicaid