Provider Demographics
NPI:1457326902
Name:GERBER, JONATHAN C (DC)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:C
Last Name:GERBER
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 1:12 HAVILAND ROAD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-9720
Mailing Address - Country:US
Mailing Address - Phone:518-793-5555
Mailing Address - Fax:518-793-5551
Practice Address - Street 1:12 HAVILAND ROAD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-9720
Practice Address - Country:US
Practice Address - Phone:518-793-5555
Practice Address - Fax:518-793-5551
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011021-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC11021-SWOtherWORKER'S COMP
NYC11021-5WOtherWORKER'S COMP
NYC11021-SWOtherWORKER'S COMP
NYAPPLIED FOR 12/05Medicare ID - Type UnspecifiedNO RESPONSE YET