Provider Demographics
NPI:1609843432
Name:GENTLE, THOMAS A (DC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:GENTLE
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 1:1213 KRESS DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3411
Mailing Address - Country:US
Mailing Address - Phone:336-896-9898
Mailing Address - Fax:336-896-9997
Practice Address - Street 1:1213 KRESS DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3411
Practice Address - Country:US
Practice Address - Phone:336-896-9898
Practice Address - Fax:336-896-9997
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2028111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC21921OtherPARTNERS
NC08440OtherBCBS
NC47261OtherAWHN
NC21921OtherPARTNERS
NC2450140Medicare ID - Type Unspecified
NC47261OtherAWHN