Provider Demographics
NPI:1336279892
Name:NANNE, GERALD E (DC)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:E
Last Name:NANNE
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 1:7556 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6431
Mailing Address - Country:US
Mailing Address - Phone:440-239-0022
Mailing Address - Fax:440-239-0024
Practice Address - Street 1:7556 PEARL RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-6431
Practice Address - Country:US
Practice Address - Phone:440-239-0022
Practice Address - Fax:440-239-0024
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2553111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2118514Medicaid
OH34-1892194OtherTAX IDENTIFICATION NUMBER
OH000000141574OtherBLUE CROSS BLUE SHIELD
OH000000141574OtherBLUE CROSS BLUE SHIELD
OH34-1892194OtherTAX IDENTIFICATION NUMBER