Provider Demographics
NPI:1144706730
Name:CERVONE, GARY (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:CERVONE
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 1:3683 GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2906
Mailing Address - Country:US
Mailing Address - Phone:614-539-4128
Mailing Address - Fax:888-631-0223
Practice Address - Street 1:1358A CHERRY BOTTOM RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6771
Practice Address - Country:US
Practice Address - Phone:614-471-2225
Practice Address - Fax:614-471-4260
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-04825111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor