Provider Demographics
NPI:1629019435
Name:ISAKSON, GERALD E (DC)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:E
Last Name:ISAKSON
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 1:1149 FIRST AVE SE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-1201
Mailing Address - Country:US
Mailing Address - Phone:712-722-0071
Mailing Address - Fax:
Practice Address - Street 1:1149 FIRST AVE SE
Practice Address - Street 2:
Practice Address - City:SIOUX CENTER
Practice Address - State:IA
Practice Address - Zip Code:51250-1201
Practice Address - Country:US
Practice Address - Phone:712-722-0071
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0147413Medicaid
T00894Medicare UPIN
IA0147413Medicaid