Provider Demographics
NPI:1083770242
Name:BEMIS, GERALD HENRY (DC)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:HENRY
Last Name:BEMIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5126
Mailing Address - Country:US
Mailing Address - Phone:618-466-5322
Mailing Address - Fax:
Practice Address - Street 1:240 W ELM ST
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5126
Practice Address - Country:US
Practice Address - Phone:618-466-5322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038003469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5509595OtherAETNA
IL038003469Medicaid
IL6082013OtherBLUE CROSS BLUE SHEILD IL
IL4400105OtherUNITED HEALTHCARE
IL102803OtherHEALTH LINK
IL4400105OtherUNITED HEALTHCARE
IL6082013OtherBLUE CROSS BLUE SHEILD IL