Provider Demographics
NPI:1184624777
Name:LOISELLE, GARY A (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:LOISELLE
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 1:28925 7 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3503
Mailing Address - Country:US
Mailing Address - Phone:248-474-0800
Mailing Address - Fax:248-474-0800
Practice Address - Street 1:28925 7 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3503
Practice Address - Country:US
Practice Address - Phone:248-474-0800
Practice Address - Fax:248-474-0800
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004943111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11282193OtherCAQH
MI1749390Medicaid
MI0Q25117OtherBC/BS
MI1749390Medicaid
MI11282193OtherCAQH