Provider Demographics
NPI:1396964524
Name:CHARLES C GERLEMAN D C P C
Entity type:Organization
Organization Name:CHARLES C GERLEMAN D C P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:GERLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-322-2370
Mailing Address - Street 1:119 RODEWALD DR
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62681-9783
Mailing Address - Country:US
Mailing Address - Phone:217-322-2370
Mailing Address - Fax:217-322-2874
Practice Address - Street 1:119 RODEWALD DR
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62681-9783
Practice Address - Country:US
Practice Address - Phone:217-322-2370
Practice Address - Fax:217-322-2874
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
IL060009113111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08530076OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
IL08530076OtherBLUE CROSS BLUE SHIELD OF ILLINOIS