Provider Demographics
NPI:1205949716
Name:HENNING, GUNNAR M (DC)
Entity type:Individual
Prefix:DR
First Name:GUNNAR
Middle Name:M
Last Name:HENNING
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 1:101 PENNSYLVANIA AVE
Mailing Address - Street 2:ROUTE 31
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-1201
Mailing Address - Country:US
Mailing Address - Phone:908-751-5706
Mailing Address - Fax:908-751-5708
Practice Address - Street 1:101 PENNSYLVANIA AVE
Practice Address - Street 2:ROUTE 31
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1201
Practice Address - Country:US
Practice Address - Phone:908-751-5706
Practice Address - Fax:908-751-5708
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00222600111N00000X
PADC002389L111N00000X
NC1339111N00000X
VA0104000361111N00000X
MA230989111N00000X
NYX003079-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ172056Medicare PIN
T83796Medicare UPIN