Provider Demographics
NPI:1629143854
Name:KLIDA, GERALD D (DC)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:D
Last Name:KLIDA
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 1:21617 E 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1811
Mailing Address - Country:US
Mailing Address - Phone:586-776-6844
Mailing Address - Fax:
Practice Address - Street 1:21617 EAST NINE MILE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1811
Practice Address - Country:US
Practice Address - Phone:586-776-6844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301002860111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0E051768951Medicare ID - Type Unspecified
T33682Medicare UPIN