Healthcare Provider Details

I. General information

NPI: 1699753707
Provider Name (Legal Business Name): GERALD LEE ZUMWALT BS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9242 IL RT 16
HILLSBORO IL
62049
US

IV. Provider business mailing address

PO BOX 597 9242 IL RT 16
HILLSBORO IL
62049
US

V. Phone/Fax

Practice location:
  • Phone: 217-532-6124
  • Fax:
Mailing address:
  • Phone: 217-532-6124
  • Fax: 217-532-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038003307
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: