Provider Demographics
NPI:1053846493
Name:GILEAD RIVER OF LIFE, PLLC
Entity type:Organization
Organization Name:GILEAD RIVER OF LIFE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAIGNEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:517-896-2971
Mailing Address - Street 1:306 S CREYTS RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8289
Mailing Address - Country:US
Mailing Address - Phone:517-319-5818
Mailing Address - Fax:517-319-5872
Practice Address - Street 1:306 S CREYTS RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8289
Practice Address - Country:US
Practice Address - Phone:517-319-5818
Practice Address - Fax:517-319-5872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007956111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty