Provider Demographics
NPI:1164507885
Name:GERADS, MARCELLA S (DC, DABCO)
Entity Type:Individual
Prefix:DR
First Name:MARCELLA
Middle Name:S
Last Name:GERADS
Suffix:
Gender:F
Credentials:DC, DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-5201
Mailing Address - Country:US
Mailing Address - Phone:715-341-4826
Mailing Address - Fax:
Practice Address - Street 1:2516 CHURCH ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-5201
Practice Address - Country:US
Practice Address - Phone:715-341-4826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3038111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI050336Medicare UPIN