Provider Demographics
NPI:1295802569
Name:WERDER, GERARD JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:JOSEPH
Last Name:WERDER
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 1:253 W UTICA ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-2019
Mailing Address - Country:US
Mailing Address - Phone:716-884-3019
Mailing Address - Fax:716-884-1300
Practice Address - Street 1:253 W UTICA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2019
Practice Address - Country:US
Practice Address - Phone:716-884-3019
Practice Address - Fax:716-884-1300
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX22170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY077051Medicare ID - Type Unspecified