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General NPI Number Information
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NPI Number | 1982089025
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Entity Type | Organization
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Legal Business Name | GERARD CHIROPRACTIC
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Dates
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Enumeration Date | 07/29/2015
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 112 WEST DAVENPORT ST UNIT 1
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City | ELDRIDGE
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State | IA
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Zip | 52748
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Country | US
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Telephone | 563-223-9120
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Fax |
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Provider Business Mailing Address
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Address Line | 112 WEST DAVENPORT ST UNIT 1
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City | ELDRIDGE
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State | IA
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Zip | 52748
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Country | US
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Telephone | 563-223-9120
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | SHAWN M GERARD
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Credential | D.C
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Telephone | 563-223-9120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 078973
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 078973
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License Number State | IA
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