Provider Demographics
NPI:1912087149
Name:WERTEL, GERALD JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:JOSEPH
Last Name:WERTEL
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 1:5203 CHIPPEWA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2356
Mailing Address - Country:US
Mailing Address - Phone:314-352-7000
Mailing Address - Fax:314-352-7002
Practice Address - Street 1:5203 CHIPPEWA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2356
Practice Address - Country:US
Practice Address - Phone:314-352-7000
Practice Address - Fax:314-352-7002
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200101169111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO154371OtherBLUECROSS BLUESHIELD ID #
MO990001831Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
MO33303Medicare PIN
MO154371OtherBLUECROSS BLUESHIELD ID #