Individual provider Active NPI

Adam Blair Gentry, D.C.

  • Chiropractor
  • Summerville, SC
National Provider Identifier
1982661963
Registry record updated Sep 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2478 Issued in SC
Practice address
1115 Central Ave
Summerville, SC 29483-3072
Phone
(843) 832-4499
Fax
(843) 832-4978
NPI assigned
Apr 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2478 SC Primary

Addresses

Primary practice location

1115 Central Ave
Summerville, SC 29483-3072

Mailing address

1115 Central Ave
Summerville, SC 29483-3072
Phone (843) 832-4499

Other identifiers 1

IdentifierTypeStateIssuer
CH2478MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2478SCMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Freedom Chiropractic, PLLC Chiropractor PastSince Sep 21, 2009 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189382400000",
    "number": "1982661963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 CENTRAL AVE",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294833072",
            "telephone_number": "843-832-4499",
            "fax_number": "843-832-4978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 CENTRAL AVE",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294833072",
            "telephone_number": "843-832-4499",
            "fax_number": "843-832-4978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENTRY",
        "first_name": "ADAM",
        "middle_name": "BLAIR",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2007-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "SC",
            "license": "2478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CH2478",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Summerville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.