Provider Demographics
NPI:1164496303
Name:GENTILE, JOHN J (DC)
Entity Type:Individual
Prefix:PROF
First Name:JOHN
Middle Name:J
Last Name:GENTILE
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 1:8056 SW 81ST DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6609
Mailing Address - Country:US
Mailing Address - Phone:305-271-1652
Mailing Address - Fax:305-271-1855
Practice Address - Street 1:8056 SW 81ST DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-6609
Practice Address - Country:US
Practice Address - Phone:305-271-1652
Practice Address - Fax:305-271-1855
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1864111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT56126Medicare UPIN
FL89187Medicare ID - Type Unspecified