Provider Demographics
NPI:1548348568
Name:GLEASON, MICHAEL A (RN DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:GLEASON
Suffix:
Gender:M
Credentials:RN 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 245
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-0245
Mailing Address - Country:US
Mailing Address - Phone:603-890-3486
Mailing Address - Fax:
Practice Address - Street 1:31 LOWELL RD
Practice Address - Street 2:SUITE 5
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-1811
Practice Address - Country:US
Practice Address - Phone:603-890-3486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH074-0491111N00000X
MA1796111N00000X
NYX006324-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0502198YONH01OtherANTHEM BLUE CROSS
MAY36336OtherBLUE CROSS MASSACHUSETTS
NHGLRE2593Medicare ID - Type Unspecified
MAY36336OtherBLUE CROSS MASSACHUSETTS