Provider Demographics
NPI:1164529897
Name:GILENSON, ALAN MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:MICHAEL
Last Name:GILENSON
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 1:3550 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:112
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-7049
Mailing Address - Country:US
Mailing Address - Phone:770-232-9483
Mailing Address - Fax:770-232-9493
Practice Address - Street 1:3550 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:112
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-7049
Practice Address - Country:US
Practice Address - Phone:770-232-9483
Practice Address - Fax:770-232-9493
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3101111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU47933Medicare UPIN
GA202I351696Medicare PIN
GA35ZCCPRMedicare ID - Type Unspecified