Provider Demographics
NPI:1346417789
Name:GORDON GENSEL
Entity Type:Organization
Organization Name:GORDON GENSEL
Other - Org Name:GENSEL WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:R
Authorized Official - Last Name:GENSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:831-333-1513
Mailing Address - Street 1:700 CASS ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2916
Mailing Address - Country:US
Mailing Address - Phone:831-333-1513
Mailing Address - Fax:831-333-0513
Practice Address - Street 1:700 CASS ST
Practice Address - Street 2:SUITE 110
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2916
Practice Address - Country:US
Practice Address - Phone:831-333-1513
Practice Address - Fax:831-333-0513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty