Provider Demographics
NPI:1780649186
Name:VAN GESSEL, DANIEL GERARD (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GERARD
Last Name:VAN GESSEL
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 1:4612 PLAINFIELD NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525
Mailing Address - Country:US
Mailing Address - Phone:616-363-7713
Mailing Address - Fax:616-363-4958
Practice Address - Street 1:4612 PLAINFIELD NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-363-7713
Practice Address - Fax:616-363-4958
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDV005052111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0D15000Medicare ID - Type Unspecified