MEDICARE: DR. SCOTT ALAN GERSTENKORN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	08001684A	IN

General Provider Information

NPI Number	:	1265465173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT ALAN GERSTENKORN D.C.

Provider Business Mailing Address
First Line	:	13317 WICKER AVE
Second Line	:
City	:	CEDAR LAKE
State	:	IN
Zip	:	46303-9349
Country	:	US
Telephone Number	:	219-374-8190
Fax Number	:	219-374-8192

Provider Business Practice Location Address
First Line	:	13317 WICKER AVE
Second Line	:
City	:	CEDAR LAKE
State	:	IN
Zip	:	46303-9349
Country	:	US
Telephone Number	:	219-374-8190
Fax Number	:	219-374-8192

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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