Provider Demographics
NPI:1346366275
Name:SHOEMAKER, GARY A (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:SHOEMAKER
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 1:18720 MACK AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2993
Mailing Address - Country:US
Mailing Address - Phone:313-886-8030
Mailing Address - Fax:313-886-4350
Practice Address - Street 1:18720 MACK AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-2993
Practice Address - Country:US
Practice Address - Phone:313-886-8030
Practice Address - Fax:313-886-4350
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004518111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950H202790Medicare UPIN
MI0Q24574Medicare ID - Type Unspecified