Provider Demographics
NPI:1295720639
Name:ZUKER, GERALD ALAN (DC)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:ALAN
Last Name:ZUKER
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 1:1915 W GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1701
Mailing Address - Country:US
Mailing Address - Phone:517-347-3013
Mailing Address - Fax:517-347-2679
Practice Address - Street 1:1915 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1701
Practice Address - Country:US
Practice Address - Phone:517-347-3013
Practice Address - Fax:517-347-2679
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004660111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2123467Medicaid
MIT32884Medicare UPIN
OC35060Medicare ID - Type Unspecified