Provider Demographics
NPI:1518948256
Name:GENTRY, MICHAEL G (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:GENTRY
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 1:616 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:740-522-8720
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:740-522-8720
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1137111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor