Provider Demographics
NPI:1023110764
Name:GENSEL, GORDON RICHARD (DC)
Entity type:Individual
Prefix:
First Name:GORDON
Middle Name:RICHARD
Last Name:GENSEL
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 1:700 CASS ST
Mailing Address - Street 2:SUITE110
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2916
Mailing Address - Country:US
Mailing Address - Phone:831-333-1513
Mailing Address - Fax:
Practice Address - Street 1:700 CASS ST
Practice Address - Street 2:SUITE110
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2916
Practice Address - Country:US
Practice Address - Phone:831-333-1513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21977111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAT051ZOtherMEDICARE IDENTIFICATION NUMBER (PTAN)
U49404Medicare UPIN