Provider Demographics
NPI:1710990353
Name:GEHRUNG CHIROPRACTIC CENTER, S.C.
Entity Type:Organization
Organization Name:GEHRUNG CHIROPRACTIC CENTER, S.C.
Other - Org Name:RIVERCREST CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LUKE
Authorized Official - Last Name:GEHRUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:261-251-7711
Mailing Address - Street 1:W177N9856 RIVERCREST DR
Mailing Address - Street 2:STE. 102
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-4612
Mailing Address - Country:US
Mailing Address - Phone:262-251-7711
Mailing Address - Fax:262-251-4821
Practice Address - Street 1:W177N9856 RIVERCREST DR
Practice Address - Street 2:STE. 102
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-4612
Practice Address - Country:US
Practice Address - Phone:262-251-7711
Practice Address - Fax:262-251-4821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty