Provider Demographics
NPI:1982089025
Name:GERARD CHIROPRACTIC
Entity Type:Organization
Organization Name:GERARD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GERARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-223-9120
Mailing Address - Street 1:112 WEST DAVENPORT ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748
Mailing Address - Country:US
Mailing Address - Phone:563-223-9120
Mailing Address - Fax:
Practice Address - Street 1:112 WEST DAVENPORT ST UNIT 1
Practice Address - Street 2:
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748
Practice Address - Country:US
Practice Address - Phone:563-223-9120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078973111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty