Provider Demographics
NPI:1336443811
Name:GERSTENKORN FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:GERSTENKORN FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:GERSTENKORN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-374-8190
Mailing Address - Street 1:13317 WICKER AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46303-9349
Mailing Address - Country:US
Mailing Address - Phone:219-374-8190
Mailing Address - Fax:
Practice Address - Street 1:13317 WICKER AVE
Practice Address - Street 2:
Practice Address - City:CEDAR LAKE
Practice Address - State:IN
Practice Address - Zip Code:46303-9349
Practice Address - Country:US
Practice Address - Phone:219-374-8190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001684A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty