Provider Demographics
NPI:1710190152
Name:GENSLER, ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:GENSLER
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 1:180 WELLS AVE
Mailing Address - Street 2:SUITE 302A
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3328
Mailing Address - Country:US
Mailing Address - Phone:617-332-5105
Mailing Address - Fax:617-332-5108
Practice Address - Street 1:180 WELLS AVE
Practice Address - Street 2:SUITE 302A
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3328
Practice Address - Country:US
Practice Address - Phone:617-332-5105
Practice Address - Fax:617-332-5108
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA528111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY35368Medicare ID - Type UnspecifiedPROVIDER NUMBER