MEDICARE: DR. GERALD LEE ZUMWALT BS 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	038003307	IL

General Provider Information

NPI Number	:	1699753707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD LEE ZUMWALT BS DC

Provider Business Mailing Address
First Line	:	PO BOX 597
Second Line	:	9242 IL RT 16
City	:	HILLSBORO
State	:	IL
Zip	:	62049
Country	:	US
Telephone Number	:	217-532-6124
Fax Number	:	217-532-6414

Provider Business Practice Location Address
First Line	:	9242 IL RT 16
Second Line	:
City	:	HILLSBORO
State	:	IL
Zip	:	62049
Country	:	US
Telephone Number	:	217-532-6124
Fax Number	:

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	11/23/2016

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