Provider Demographics
NPI:1336110915
Name:GENOVESE, JOHN FELIX (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FELIX
Last Name:GENOVESE
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 1:276 COLSTON DR
Mailing Address - Street 2:
Mailing Address - City:FALLING WATERS
Mailing Address - State:WV
Mailing Address - Zip Code:25419-7058
Mailing Address - Country:US
Mailing Address - Phone:304-274-3411
Mailing Address - Fax:
Practice Address - Street 1:305 MEDICAL CT
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2843
Practice Address - Country:US
Practice Address - Phone:304-267-4041
Practice Address - Fax:304-267-4010
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV435111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131351000Medicaid
WVGE0593132Medicare ID - Type Unspecified
WVT95675Medicare UPIN