Provider Demographics
NPI:1508009986
Name:GENNERO, REBECCA RUTH (DC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:RUTH
Last Name:GENNERO
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 1:11437 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-3809
Mailing Address - Country:US
Mailing Address - Phone:586-264-4700
Mailing Address - Fax:586-264-1955
Practice Address - Street 1:11437 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-3809
Practice Address - Country:US
Practice Address - Phone:586-264-4700
Practice Address - Fax:586-264-1955
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor