Provider Demographics
NPI:1548315534
Name:GULYAS, MARK STEPHEN (DC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEPHEN
Last Name:GULYAS
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 1:33143 S GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4037
Mailing Address - Country:US
Mailing Address - Phone:586-791-4880
Mailing Address - Fax:
Practice Address - Street 1:33143 S GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-4037
Practice Address - Country:US
Practice Address - Phone:586-791-4880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004905111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E05036Medicare PIN