Provider Demographics
NPI:1104984244
Name:VERCELLOTTI, GERALD A (DC)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:A
Last Name:VERCELLOTTI
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 1:1000 S HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-3468
Mailing Address - Country:US
Mailing Address - Phone:815-838-4921
Mailing Address - Fax:815-838-9650
Practice Address - Street 1:1000 S HAMILTON ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:IL
Practice Address - Zip Code:60441-3468
Practice Address - Country:US
Practice Address - Phone:815-838-4921
Practice Address - Fax:815-838-9650
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0009915045OtherBCBS
IL0009915045OtherBCBS