Provider Demographics
NPI:1407966708
Name:GENTRY CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:GENTRY CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-522-4123
Mailing Address - Street 1:616 HEBRON RD
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:OH
Mailing Address - Zip Code:43056-1444
Mailing Address - Country:US
Mailing Address - Phone:740-522-4123
Mailing Address - Fax:
Practice Address - Street 1:616 HEBRON RD
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1444
Practice Address - Country:US
Practice Address - Phone:740-522-4123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHGE9321411Medicare PIN