Healthcare Provider Details

I. General information

NPI: 1053475079
Provider Name (Legal Business Name): ROBERT J GERKEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 JOHNSBURG ROAD
JOHNSBURG IL
60051-5105
US

IV. Provider business mailing address

2604 JOHNSBURG ROAD
JOHNSBURG IL
60051-5105
US

V. Phone/Fax

Practice location:
  • Phone: 815-578-1771
  • Fax: 815-578-9261
Mailing address:
  • Phone: 815-578-1771
  • Fax: 815-578-9261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038-009638
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: