Provider Demographics
NPI:1922148212
Name:GENTNER, JUDITH KRAMER (DC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:KRAMER
Last Name:GENTNER
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 1:13708 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4711
Mailing Address - Country:US
Mailing Address - Phone:216-221-2008
Mailing Address - Fax:216-221-6446
Practice Address - Street 1:13708 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4711
Practice Address - Country:US
Practice Address - Phone:216-221-2008
Practice Address - Fax:216-221-6446
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1884111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34-1780993OtherTAX ID
OH34-1780993OtherTAX ID
OHGE4068391Medicare ID - Type Unspecified