Provider Demographics
NPI:1205407293
Name:VANDEVENTER, GENNIFER (DC)
Entity Type:Individual
Prefix:
First Name:GENNIFER
Middle Name:
Last Name:VANDEVENTER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-9302
Mailing Address - Country:US
Mailing Address - Phone:740-808-8493
Mailing Address - Fax:
Practice Address - Street 1:340 W FAIR AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1863
Practice Address - Country:US
Practice Address - Phone:740-689-0199
Practice Address - Fax:740-689-0189
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor