Provider Demographics
NPI:1306889282
Name:VANDEN HOEK, GERALD B (DC)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:B
Last Name:VANDEN HOEK
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 1:2201 S BRENTWOOD BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1847
Mailing Address - Country:US
Mailing Address - Phone:314-667-8864
Mailing Address - Fax:314-717-0010
Practice Address - Street 1:2201 S BRENTWOOD BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:BRENTWOOD
Practice Address - State:MO
Practice Address - Zip Code:63144-1847
Practice Address - Country:US
Practice Address - Phone:314-667-8864
Practice Address - Fax:314-717-0010
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO006039111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO193273OtherHEALTHLINK
MOMA5168002Medicare PIN
IL038007030Medicaid
IL193273OtherHEALTHLINK
601217900OtherDEPARTMENT OF LABOR
K11045Medicare ID - Type UnspecifiedMEDICARE NUMBER