Provider Demographics
NPI:1831545698
Name:GENNETT, BRYAN (DC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:GENNETT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:BRYAN
Other - Middle Name:
Other - Last Name:GENNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:336 ROCKWOOD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-8616
Mailing Address - Country:US
Mailing Address - Phone:828-280-1437
Mailing Address - Fax:
Practice Address - Street 1:336 ROCKWOOD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-8616
Practice Address - Country:US
Practice Address - Phone:828-280-1437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4636111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor