Provider Demographics
NPI:1811400575
Name:CRISTACHE, GIGI BADILA (DAOM, RAC)
Entity Type:Individual
Prefix:
First Name:GIGI
Middle Name:BADILA
Last Name:CRISTACHE
Suffix:
Gender:F
Credentials:DAOM, RAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30426 KNIGHTON DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1657
Mailing Address - Country:US
Mailing Address - Phone:248-790-4061
Mailing Address - Fax:
Practice Address - Street 1:32905 W 12 MILE RD STE 404
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3346
Practice Address - Country:US
Practice Address - Phone:248-790-4061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5401000064171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist