Healthcare Provider Details

I. General information

NPI: 1982089025
Provider Name (Legal Business Name): GERARD CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 WEST DAVENPORT ST UNIT 1
ELDRIDGE IA
52748
US

IV. Provider business mailing address

112 WEST DAVENPORT ST UNIT 1
ELDRIDGE IA
52748
US

V. Phone/Fax

Practice location:
  • Phone: 563-223-9120
  • Fax:
Mailing address:
  • Phone: 563-223-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number078973
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number078973
License Number StateIA

VIII. Authorized Official

Name: SHAWN M GERARD
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C
Phone: 563-223-9120