Provider Demographics
NPI:1144291568
Name:HESS, GERALD WALLACE (DC)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:WALLACE
Last Name:HESS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:HESS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:2711 W 63RD ST
Mailing Address - Street 2:#1
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806
Mailing Address - Country:US
Mailing Address - Phone:563-386-7037
Mailing Address - Fax:563-386-7037
Practice Address - Street 1:2711 W 63RD ST
Practice Address - Street 2:STE #1
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806
Practice Address - Country:US
Practice Address - Phone:563-386-7037
Practice Address - Fax:563-386-7037
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05328111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0261081Medicaid
IA26108OtherWELLMARK BC/BS
IA0261081Medicaid