Provider Demographics
NPI:1609096262
Name:CHARLES C. GERLEMAN, D.C..P.C.
Entity Type:Organization
Organization Name:CHARLES C. GERLEMAN, D.C..P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:309-343-2117
Mailing Address - Street 1:777 N HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2515
Mailing Address - Country:US
Mailing Address - Phone:309-343-2117
Mailing Address - Fax:309-343-6639
Practice Address - Street 1:777 N HENDERSON ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2515
Practice Address - Country:US
Practice Address - Phone:309-343-2117
Practice Address - Fax:309-343-6639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty