MEDICARE: MARIE GENNA PARENT DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2301004944	MI

General Provider Information

NPI Number	:	1366407629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE GENNA PARENT DC

Provider Business Mailing Address
First Line	:	PO BOX 224
Second Line	:
City	:	LAKE LEELANAU
State	:	MI
Zip	:	49653-0224
Country	:	US
Telephone Number	:	231-256-2500
Fax Number	:	231-256-2575

Provider Business Practice Location Address
First Line	:	208 WEST MAIN STREET
Second Line	:
City	:	LAKE LEELANAU
State	:	MI
Zip	:	49653
Country	:	US
Telephone Number	:	231-256-2500
Fax Number	:	231-256-2575

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	06/30/2014

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Directions to “ MARIE GENNA PARENT DC” Practice Location

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