Provider Demographics
NPI:1942255500
Name:GANSCHOW, MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GANSCHOW
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:PO BOX 1066
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-1066
Mailing Address - Country:US
Mailing Address - Phone:817-485-2400
Mailing Address - Fax:
Practice Address - Street 1:104 GRAPEVINE HWY STE 400
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-2437
Practice Address - Country:US
Practice Address - Phone:817-285-2400
Practice Address - Fax:817-485-2475
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8687111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1708224Medicaid
TX1708224Medicaid