Provider Demographics
NPI:1629529656
Name:NEXT GEN CHIROPRACTIC WELLNESS AND PERFORMANCE CENTER
Entity Type:Organization
Organization Name:NEXT GEN CHIROPRACTIC WELLNESS AND PERFORMANCE CENTER
Other - Org Name:NEXT GEN CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-280-1437
Mailing Address - Street 1:336 ROCKWOOD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-8616
Mailing Address - Country:US
Mailing Address - Phone:828-280-1437
Mailing Address - Fax:
Practice Address - Street 1:336 ROCKWOOD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-8616
Practice Address - Country:US
Practice Address - Phone:828-280-1437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4636111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCT884F700OtherMEDICARE ID