MEDICARE: DR. GERALD JOHN LOGAN DC

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	000806	CT

General Provider Information

NPI Number	:	1295723641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD JOHN LOGAN DC

Provider Business Mailing Address
First Line	:	1 BRIDGEPORT AVE
Second Line	:
City	:	SHELTON
State	:	CT
Zip	:	06484-3211
Country	:	US
Telephone Number	:	203-922-1212
Fax Number	:	203-922-1202

Provider Business Practice Location Address
First Line	:	1 BRIDGEPORT AVE
Second Line	:
City	:	SHELTON
State	:	CT
Zip	:	06484-3211
Country	:	US
Telephone Number	:	203-922-1212
Fax Number	:	203-922-1202

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. GERALD JOHN LOGAN DC” Practice Location

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