Provider Demographics
NPI:1053475079
Name:GERKEN, ROBERT J (DC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:J
Last Name:GERKEN
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 1:2604 JOHNSBURG ROAD
Mailing Address - Street 2:
Mailing Address - City:JOHNSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60051-5105
Mailing Address - Country:US
Mailing Address - Phone:815-578-1771
Mailing Address - Fax:815-578-9261
Practice Address - Street 1:2604 JOHNSBURG ROAD
Practice Address - Street 2:
Practice Address - City:JOHNSBURG
Practice Address - State:IL
Practice Address - Zip Code:60051-5105
Practice Address - Country:US
Practice Address - Phone:815-578-1771
Practice Address - Fax:815-578-9261
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-009638111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL13-4207401OtherACN
IL44-02151OtherUNITED HEALTHCARE
IL13-4207401OtherACN
IL203738Medicare UPIN
IL05632038Medicare UPIN