Provider Demographics
NPI:1710961222
Name:GERVIS, MICHAEL W (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:GERVIS
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 1:50 PRINCETON HIGHTSTOWN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-1107
Mailing Address - Country:US
Mailing Address - Phone:609-897-0009
Mailing Address - Fax:609-897-0900
Practice Address - Street 1:50 PRINCETON HIGHTSTOWN RD
Practice Address - Street 2:SUITE D
Practice Address - City:PRINCETON JUNCTION
Practice Address - State:NJ
Practice Address - Zip Code:08550-1107
Practice Address - Country:US
Practice Address - Phone:609-897-0009
Practice Address - Fax:609-897-0900
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor