Provider Demographics
NPI:1780748327
Name:GILEROVICH, MARC A (DC)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:GILEROVICH
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 1:985 W OKLAHOMA AVENUE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-4749
Mailing Address - Country:US
Mailing Address - Phone:414-481-1021
Mailing Address - Fax:414-481-3044
Practice Address - Street 1:W164 N11297 SQUIRE DRIVE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022
Practice Address - Country:US
Practice Address - Phone:262-250-1948
Practice Address - Fax:262-250-1004
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3602012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004OtherMEDICARE SEQUENCE NUMBER
35686Medicare ID - Type Unspecified
U77672Medicare UPIN