Provider Demographics
NPI:1710191093
Name:GEHNRICH, JOHN R (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:GEHNRICH
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 1:25 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5214
Mailing Address - Country:US
Mailing Address - Phone:516-536-6000
Mailing Address - Fax:516-536-6100
Practice Address - Street 1:25 S PARK AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5214
Practice Address - Country:US
Practice Address - Phone:516-536-6000
Practice Address - Fax:516-536-6100
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008857111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5897588OtherGHI
NEP1953527OtherOXFORD
NY2310908OtherAETNA
NY5897588OtherGHI
NYX2D801Medicare ID - Type Unspecified