Provider Demographics
NPI:1861495392
Name:GASIECKI, MICHAEL EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:GASIECKI
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 1:60 N ROUNTREE ST
Mailing Address - Street 2:
Mailing Address - City:METTER
Mailing Address - State:GA
Mailing Address - Zip Code:30439-4019
Mailing Address - Country:US
Mailing Address - Phone:912-685-2324
Mailing Address - Fax:912-685-2324
Practice Address - Street 1:60 N ROUNTREE ST
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439-4019
Practice Address - Country:US
Practice Address - Phone:912-685-2324
Practice Address - Fax:912-685-2324
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007703111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV01303Medicare UPIN
GA35ZCHVRMedicare ID - Type UnspecifiedMEDICARE