Provider Demographics
NPI:1942474986
Name:KLEMM, JERALD WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:JERALD
Middle Name:WILLIAM
Last Name:KLEMM
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 1:6334 COLUMBIA PIKE
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-1219
Mailing Address - Country:US
Mailing Address - Phone:703-941-3601
Mailing Address - Fax:
Practice Address - Street 1:6334 COLUMBIA PIKE
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-1219
Practice Address - Country:US
Practice Address - Phone:703-941-3601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000410111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01602K01Medicare PIN