Healthcare Provider Details

I. General information

NPI: 1174583678
Provider Name (Legal Business Name): DENNIS J GERLEMAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 TENNEY ST
KEWANEE IL
61443
US

IV. Provider business mailing address

320 TENNEY ST
KEWANEE IL
61443
US

V. Phone/Fax

Practice location:
  • Phone: 309-852-6555
  • Fax: 309-852-6554
Mailing address:
  • Phone: 309-852-6555
  • Fax: 309-852-6554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: