Healthcare Provider Details

I. General information

NPI: 1467152959
Provider Name (Legal Business Name): MARSHALL GEVERS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 04/20/2023
Certification Date: 04/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 S STATE ROUTE 159 STE 2
GLEN CARBON IL
62034-3231
US

IV. Provider business mailing address

9009 MAPLE RD
EDWARDSVILLE IL
62025-6355
US

V. Phone/Fax

Practice location:
  • Phone: 618-520-8270
  • Fax:
Mailing address:
  • Phone: 618-520-8270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.013971
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: