Provider Demographics
NPI:1497782155
Name:GLADISH, MARY E (DC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:GLADISH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 CLYDE PARK AVE SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49509-4036
Mailing Address - Country:US
Mailing Address - Phone:616-532-4500
Mailing Address - Fax:616-532-7344
Practice Address - Street 1:4315 CLYDE PARK AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-4036
Practice Address - Country:US
Practice Address - Phone:616-532-4500
Practice Address - Fax:616-532-7344
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301008725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N80220Medicare PIN