Healthcare Provider Details

I. General information

NPI: 1972587574
Provider Name (Legal Business Name): ERIC TODD GEARING D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S 3RD ST
LOUISIANA MO
63353-2060
US

IV. Provider business mailing address

122 S 3RD ST
LOUISIANA MO
63353-2060
US

V. Phone/Fax

Practice location:
  • Phone: 573-754-5005
  • Fax: 573-754-5895
Mailing address:
  • Phone: 573-754-5005
  • Fax: 573-754-5895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number6761
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: