Provider Demographics
NPI:1376567941
Name:KLEIN, GERALD E (DC)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:E
Last Name:KLEIN
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:PO BOX 824
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-0824
Mailing Address - Country:US
Mailing Address - Phone:662-862-2071
Mailing Address - Fax:662-862-2071
Practice Address - Street 1:101 WHEELER DR SUITE B
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843
Practice Address - Country:US
Practice Address - Phone:662-862-2071
Practice Address - Fax:662-862-2071
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0990111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121531Medicaid
MS00121531Medicaid