Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 2017030082 | MO |
N | 111N00000X | Chiropractor | 2301010596 | MI |
Y | 111NR0400X | Rehabilitation Chiropractor | 2301010596 | MI |
NPI | 1366957144 |
---|---|
Provider Name | Candace C Gorges |
First Address | Birch Run, MI 48415-9232 |
Second Address | Birch Run, MI 48415-9232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2017 |
Last Update Date | 05/10/2020 |