Provider Demographics
NPI:1093904757
Name:GENTLE CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:GENTLE CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KASEGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-941-6767
Mailing Address - Street 1:739 POST RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-1852
Mailing Address - Country:US
Mailing Address - Phone:401-941-6767
Mailing Address - Fax:401-941-7870
Practice Address - Street 1:739 POST RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-1852
Practice Address - Country:US
Practice Address - Phone:401-941-6767
Practice Address - Fax:401-941-7870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00242111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIT53399Medicare UPIN