Healthcare Provider Details

I. General information

NPI: 1477515708
Provider Name (Legal Business Name): JENNIFER JAYNE GERLEMAN DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 RODEWALD DR
RUSHVILLE IL
62681-9783
US

IV. Provider business mailing address

119 RODEWALD DR
RUSHVILLE IL
62681-9783
US

V. Phone/Fax

Practice location:
  • Phone: 217-322-2370
  • Fax: 217-322-2874
Mailing address:
  • Phone: 217-322-2370
  • Fax: 217-322-2874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038009332
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: