Provider Demographics
NPI:1407030653
Name:GENTHNER, STEPHEN MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:GENTHNER
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 1:355 CRAWFORD ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2816
Mailing Address - Country:US
Mailing Address - Phone:757-399-4700
Mailing Address - Fax:757-399-0011
Practice Address - Street 1:355 CRAWFORD ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2816
Practice Address - Country:US
Practice Address - Phone:757-399-4700
Practice Address - Fax:757-399-0011
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011498111N00000X
VA0104556637111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor