Provider Demographics
NPI:1396423695
Name:GENTRY CHIROPRACTIC INC
Entity type:Organization
Organization Name:GENTRY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-888-0404
Mailing Address - Street 1:30486 AVENIDA DE LAS BANDERAS STE D
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3948
Mailing Address - Country:US
Mailing Address - Phone:949-888-0404
Mailing Address - Fax:
Practice Address - Street 1:30486 AVENIDA DE LAS BANDERAS STE D
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3948
Practice Address - Country:US
Practice Address - Phone:949-888-0404
Practice Address - Fax:949-888-0818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty