Provider Demographics
NPI:1750303566
Name:GEROU, THOMAS J (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:GEROU
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 1:7277 N LILLEY RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2434
Mailing Address - Country:US
Mailing Address - Phone:734-981-6969
Mailing Address - Fax:734-416-3976
Practice Address - Street 1:7277 N LILLEY RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2434
Practice Address - Country:US
Practice Address - Phone:734-981-6969
Practice Address - Fax:734-416-3976
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005337111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1839415Medicaid
MIP79012OtherBLUE CARE NETWORK
MIOH25202951OtherBCBS OF MI
T33722Medicare UPIN
MI1839415Medicaid