Provider Demographics
NPI:1124247416
Name:HARMON, GWENDOLYN DENISE (DC)
Entity type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:DENISE
Last Name:HARMON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8529 N DIXIE DR STE 600
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2477
Mailing Address - Country:US
Mailing Address - Phone:937-665-0440
Mailing Address - Fax:937-665-0465
Practice Address - Street 1:8529 N DIXIE DR STE 600
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-2477
Practice Address - Country:US
Practice Address - Phone:937-665-0440
Practice Address - Fax:937-665-0465
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3634111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHV09113Medicare UPIN
OH4181541Medicare PIN