Provider Demographics
NPI:1558349191
Name:POPEJOY, GERRED LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:GERRED
Middle Name:LEE
Last Name:POPEJOY
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 1:100 S HARDING
Mailing Address - Street 2:STE 3D
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678
Mailing Address - Country:US
Mailing Address - Phone:916-783-4240
Mailing Address - Fax:916-783-0962
Practice Address - Street 1:100 S HARDING
Practice Address - Street 2:STE 3D
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678
Practice Address - Country:US
Practice Address - Phone:916-783-4240
Practice Address - Fax:916-783-0962
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0127940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0127940Medicare ID - Type Unspecified