Provider Demographics
NPI:1407855281
Name:GENTLE, JUNE V (DC)
Entity Type:Individual
Prefix:DR
First Name:JUNE
Middle Name:V
Last Name:GENTLE
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 1:3535 US HIGHWAY 17 STE 11
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-7139
Mailing Address - Country:US
Mailing Address - Phone:904-644-8100
Mailing Address - Fax:305-644-8101
Practice Address - Street 1:3535 US HIGHWAY 17 STE 11
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-7139
Practice Address - Country:US
Practice Address - Phone:904-644-8100
Practice Address - Fax:305-644-8101
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH7065111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380953600Medicaid
FL380953600Medicaid
FL55412Medicare ID - Type Unspecified