Provider Demographics
NPI:1497784367
Name:GEDERS, STEPHEN F (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:F
Last Name:GEDERS
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 1:1504 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-1401
Mailing Address - Country:US
Mailing Address - Phone:260-358-1111
Mailing Address - Fax:260-358-4603
Practice Address - Street 1:1504 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-1401
Practice Address - Country:US
Practice Address - Phone:260-358-1111
Practice Address - Fax:260-358-4603
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000088068OtherANTHEM/BLUE CROSS PROV #
IN100138330AMedicaid
IN08001152OtherSTATE LICENSE TO PRACTICE
IN000000088068OtherANTHEM/BLUE CROSS PROV #