Provider Demographics
NPI:1114164498
Name:GENSLER, MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:GENSLER
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 1:110 E. SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62675-1340
Mailing Address - Country:US
Mailing Address - Phone:217-632-7599
Mailing Address - Fax:217-632-7505
Practice Address - Street 1:110 E. SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:IL
Practice Address - Zip Code:62675-1340
Practice Address - Country:US
Practice Address - Phone:217-632-7599
Practice Address - Fax:217-632-7505
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038011323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor