Provider Demographics
NPI:1437321817
Name:GENNERO CHIROPRACTIC LIFE CENTER
Entity Type:Organization
Organization Name:GENNERO CHIROPRACTIC LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCHI
Authorized Official - Middle Name:SALVATORE
Authorized Official - Last Name:GENNERO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-373-2570
Mailing Address - Street 1:3425 FIVE POINTS DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-2341
Mailing Address - Country:US
Mailing Address - Phone:248-373-2570
Mailing Address - Fax:248-373-4077
Practice Address - Street 1:3425 FIVE POINTS DR
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2341
Practice Address - Country:US
Practice Address - Phone:248-373-2570
Practice Address - Fax:248-373-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950F356930OtherBCBSM
MI2910041Medicaid
MIZNPCHIROOtherHAP
MI950F353250OtherBCBSM
MI2910041Medicaid
MI950F356930OtherBCBSM