Provider Demographics
NPI:1881765147
Name:PEASE, GERALD STUART (DC)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:STUART
Last Name:PEASE
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:PO BOX 2962
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92202-2962
Mailing Address - Country:US
Mailing Address - Phone:760-347-1503
Mailing Address - Fax:
Practice Address - Street 1:MOBILE CHIROPRACTICE
Practice Address - Street 2:EASTERN COACHELLA VALLEY OF RIVERSIDE COUNTY
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-347-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA15698111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T90076Medicare UPIN
DC0156980Medicare ID - Type Unspecified