Provider Demographics
NPI:1427266568
Name:GCC CHIROPRACTIC OF GRAND BLANC PLC
Entity type:Organization
Organization Name:GCC CHIROPRACTIC OF GRAND BLANC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:GENNERO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:810-694-2200
Mailing Address - Street 1:11319 SOUTH SAGINAW STREET
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1268
Mailing Address - Country:US
Mailing Address - Phone:810-694-2200
Mailing Address - Fax:810-694-6750
Practice Address - Street 1:11319 SOUTH SAGINAW STREET
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1268
Practice Address - Country:US
Practice Address - Phone:810-694-2200
Practice Address - Fax:810-694-6750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007830111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1006672OtherMCLAREN HEALTH ADVANTAGE
MI950B511800OtherBCBS OF MI
01006003OtherHEALTHPLUS
P00009050OtherMEDICARE RAILROAD CARRIER
MI950B511800OtherBCBS OF MI