Provider Demographics
NPI:1801017629
Name:GEHRIG, RENEE B (DO)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:B
Last Name:GEHRIG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 EASTERLY PARKWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-6300
Mailing Address - Country:US
Mailing Address - Phone:814-231-0717
Mailing Address - Fax:814-231-0751
Practice Address - Street 1:233 EASTERLY PARKWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801
Practice Address - Country:US
Practice Address - Phone:814-231-0717
Practice Address - Fax:814-231-0751
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC-004652-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012538880002Medicaid
PAU19006Medicare UPIN
PA679073Medicare ID - Type UnspecifiedMEDICARE ID NUMBER