Provider Demographics
NPI:1396964292
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:CHIROPRACTIC ORTHOPEDIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GERLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-852-6555
Mailing Address - Street 1:320 TENNEY ST
Mailing Address - Street 2:
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-3452
Mailing Address - Country:US
Mailing Address - Phone:309-852-6555
Mailing Address - Fax:309-852-6554
Practice Address - Street 1:320 TENNEY ST
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443-3452
Practice Address - Country:US
Practice Address - Phone:309-852-6555
Practice Address - Fax:309-852-6554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060.009010111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL038004728Medicaid
ILT38299Medicare UPIN