Provider Demographics
NPI:1366011009
Name:GENGELBACH, ALEXA ELIZABETH (DC)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:ELIZABETH
Last Name:GENGELBACH
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 1:1430 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-1404
Mailing Address - Country:US
Mailing Address - Phone:812-547-8692
Mailing Address - Fax:
Practice Address - Street 1:1430 MAIN ST
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-1404
Practice Address - Country:US
Practice Address - Phone:812-547-8692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003241A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor