Provider Demographics
NPI:1669299004
Name:GENNA, CASEY (DC)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:GENNA
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 1:148 13TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-6585
Mailing Address - Country:US
Mailing Address - Phone:909-418-4770
Mailing Address - Fax:
Practice Address - Street 1:5870 E NAPLES PLZ
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5005
Practice Address - Country:US
Practice Address - Phone:562-544-4791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35237111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor