Provider Demographics
NPI:1679950836
Name:GENGENBACH, MARIANNE S (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:S
Last Name:GENGENBACH
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 1:989 REHWINKEL RD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-3456
Mailing Address - Country:US
Mailing Address - Phone:850-590-8334
Mailing Address - Fax:850-926-4278
Practice Address - Street 1:989 REHWINKEL RD
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-3456
Practice Address - Country:US
Practice Address - Phone:850-590-8334
Practice Address - Fax:850-926-4278
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6510111N00000X, 111NP0017X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor