Provider Demographics
NPI:1457598856
Name:GENNERO, BRIAN JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:JOSEPH
Last Name:GENNERO
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 1:15663 LAUREN
Mailing Address - Street 2:
Mailing Address - City:FRASER
Mailing Address - State:MI
Mailing Address - Zip Code:48026-2630
Mailing Address - Country:US
Mailing Address - Phone:586-215-7868
Mailing Address - Fax:866-780-1895
Practice Address - Street 1:14445 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-5512
Practice Address - Country:US
Practice Address - Phone:586-268-6868
Practice Address - Fax:586-268-3540
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009351111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor