Healthcare Provider Details

I. General information

NPI: 1497784367
Provider Name (Legal Business Name): STEPHEN F GEDERS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 N JEFFERSON ST
HUNTINGTON IN
46750-1401
US

IV. Provider business mailing address

1504 N JEFFERSON ST
HUNTINGTON IN
46750-1401
US

V. Phone/Fax

Practice location:
  • Phone: 260-358-1111
  • Fax: 260-358-4603
Mailing address:
  • Phone: 260-358-1111
  • Fax: 260-358-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001152
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: