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General NPI Number Information
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NPI Number | 1821276403
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Entity Type | Organization
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Legal Business Name | GENER SPINE AND WELLNESS CENTER, LLC.
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 12100 HIGHWAY 41 N SUITE 4
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City | EVANSVILLE
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State | IN
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Zip | 47725-7032
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Country | US
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Telephone | 812-867-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 12100 HIGHWAY 41 N SUITE 4
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City | EVANSVILLE
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State | IN
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Zip | 47725-7032
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Country | US
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Telephone | 812-867-1400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON LOPEZ GENER
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Credential | D.C.
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Telephone | 812-453-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 08002361A
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License Number State | IN
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