Provider Demographics
NPI:1063506301
Name:GENTHER, WILLIAM CHARLES (DC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CHARLES
Last Name:GENTHER
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 1:3835 CANTEBURY ROAD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403
Mailing Address - Country:US
Mailing Address - Phone:910-791-2321
Mailing Address - Fax:
Practice Address - Street 1:2470 DELANEY AVENUE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403
Practice Address - Country:US
Practice Address - Phone:910-762-1258
Practice Address - Fax:910-762-9378
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1198111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08443OtherBCBS INDIVIDUAL PROVIDER
NC8908443Medicaid
NC8908443Medicaid
NC244560Medicare PIN