Provider Demographics
NPI:1720063415
Name:GASSNER, RENE (DC)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:
Last Name:GASSNER
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 1:15425 MANCHESTER RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3077
Mailing Address - Country:US
Mailing Address - Phone:636-527-6333
Mailing Address - Fax:636-527-6334
Practice Address - Street 1:15425 MANCHESTER RD
Practice Address - Street 2:SUITE 11
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3077
Practice Address - Country:US
Practice Address - Phone:636-527-6333
Practice Address - Fax:636-527-6334
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004017945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO257024399Medicare PIN