Clyde Park Chiropractic, P.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2301008725 Issued in MI

Legal business name

CLYDE PARK CHIROPRACTIC, P.C.

Practice address

4315 Clyde Park Ave SW
Wyoming, MI 49509-4101

Phone

(616) 532-4500

Fax

(616) 532-7344

NPI assigned

Nov 3, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mary E. Gladish, D.C.NPI 1497782155

Title

President

Phone

(616) 532-4500

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary E Gladish, D.C.

  • Chiropractor
  • Wyoming, MI
  • NPI 1497782155
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225670400000",
    "number": "1811140858",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4315 CLYDE PARK AVE SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495094101",
            "telephone_number": "616-532-4500",
            "fax_number": "616-532-7344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4315 CLYDE PARK AVE SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495094101",
            "telephone_number": "616-532-4500",
            "fax_number": "616-532-7344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLYDE PARK CHIROPRACTIC, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-03",
        "last_updated": "2008-11-03",
        "status": "A",
        "authorized_official_last_name": "GLADISH",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-532-4500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301008725",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeremiah Gordon Clarke, DC
• Joshua Clements
• Carly Cleveland, COTA
• Anne Clocklin
• Erin Elizabeth Clover, PA-C
• Clyde Park Pediatrics, P.C.
• Allan G Coates, DO
• Joanne Renee Coates, MSN, FNP
• Sharyn Armstrong Coates, MSOTR/L, BCB-PMD
• Erin Cobb, NP-C

• Chiropractor in Wyoming, MI
• Providers in Wyoming, MI by specialty
• Chiropractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.