Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 078973 | IA |
N | 111NS0005X | Chiropractic Sports Physician | 078973 | IA |
NPI | 1154706265 |
---|---|
Provider Name | Shawn Gerard |
First Address | Eldridge, IA 52748-1252 |
Second Address | Eldridge, IA 52748-1252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2015 |
Last Update Date | 01/09/2015 |