Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 2301004989 | MI |
NPI | 1013038629 |
---|---|
Provider Name | Geoffrey K Sagala |
First Address | Oak Park, MI 48237-3006 |
Second Address | Oak Park, MI 48237-3006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OF35348 | BCBS OF MI (01) | MI |
U19324 | (02) | MI |