Provider Demographics
NPI:1811154248
Name:TENNERY, GERALD LEE
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:LEE
Last Name:TENNERY
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:GERALD
Other - Middle Name:LEE
Other - Last Name:TENNERY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:590 N CO RD 900 E
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-5447
Mailing Address - Country:US
Mailing Address - Phone:317-217-6086
Mailing Address - Fax:
Practice Address - Street 1:590 N COUNTY ROAD 900 E
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-5447
Practice Address - Country:US
Practice Address - Phone:317-271-6086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN564111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor