Provider Demographics
NPI:1366484164
Name:GERRARD, JERRY LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:LEE
Last Name:GERRARD
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 1:2160 E BROWN RD STE 3
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-5250
Mailing Address - Country:US
Mailing Address - Phone:480-834-7992
Mailing Address - Fax:480-969-2122
Practice Address - Street 1:2160 E BROWN RD STE 3
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-5250
Practice Address - Country:US
Practice Address - Phone:480-834-7992
Practice Address - Fax:480-969-2122
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ729111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor