Provider Demographics
NPI:1124252580
Name:DR. G.M. HENNING, D.C., P.C.
Entity type:Organization
Organization Name:DR. G.M. HENNING, D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUNNAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:HENNING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-835-1515
Mailing Address - Street 1:2 E WASHINGTON AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-1400
Mailing Address - Country:US
Mailing Address - Phone:908-835-1515
Mailing Address - Fax:908-835-1114
Practice Address - Street 1:2 E WASHINGTON AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-1400
Practice Address - Country:US
Practice Address - Phone:908-835-1515
Practice Address - Fax:908-835-1114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00222600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ456776Medicare PIN
NJT83796Medicare UPIN