Provider Demographics
NPI:1154706265
Name:GERARD, SHAWN
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:GERARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W DAVENPORT ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:ELDRIDGE
Mailing Address - State:IA
Mailing Address - Zip Code:52748-1252
Mailing Address - Country:US
Mailing Address - Phone:563-223-9120
Mailing Address - Fax:
Practice Address - Street 1:112W DAVENPORT ST 1
Practice Address - Street 2:
Practice Address - City:ELDRIDGE
Practice Address - State:IA
Practice Address - Zip Code:52748-1252
Practice Address - Country:US
Practice Address - Phone:563-223-9120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-30
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078973111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician