Provider Demographics
NPI:1346307576
Name:CHAU, GEOFFREY (DC)
Entity Type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:
Last Name:CHAU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-5600
Mailing Address - Country:US
Mailing Address - Phone:269-385-9000
Mailing Address - Fax:269-385-9001
Practice Address - Street 1:1212 S PARK ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-5600
Practice Address - Country:US
Practice Address - Phone:269-385-9000
Practice Address - Fax:269-385-9001
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008481111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON89690Medicare ID - Type Unspecified