Provider Demographics
NPI:1104031244
Name:GERWIG, WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:GERWIG
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 1:4242 N FEDERAL HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-390-7071
Mailing Address - Fax:954-567-4049
Practice Address - Street 1:4242 N FEDERAL HIGHWAY
Practice Address - Street 2:SUITE C
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-390-7071
Practice Address - Fax:954-567-4049
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH007229111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55682OtherBLUE CROSS BLUE SHIELD
FL55682OtherBLUE CROSS BLUE SHIELD