Provider Demographics
NPI:1780898486
Name:GENNERO CHIROPRACTIC HEALTH CENTER PC
Entity type:Organization
Organization Name:GENNERO CHIROPRACTIC HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:GENNERO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:248-887-8400
Mailing Address - Street 1:2230 E HIGHLAND RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48356
Mailing Address - Country:US
Mailing Address - Phone:248-887-8400
Mailing Address - Fax:248-887-7100
Practice Address - Street 1:2230 E HIGHLAND RD
Practice Address - Street 2:SUITE A
Practice Address - City:HIGHLAND
Practice Address - State:MI
Practice Address - Zip Code:48356
Practice Address - Country:US
Practice Address - Phone:248-887-8400
Practice Address - Fax:248-887-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF710110OtherBCBS
MI1785735Medicaid
MIOF710110OtherBCBS
MI1785735Medicaid