| |
122 S 3rd St Louisiana MO 63353-2060 | |
(573) 754-5005 | |
Not Available |
Full Name | |
---|---|
Speciality | Chiropractor |
Location | 122 S 3rd St, Louisiana, Missouri |
Authorized Official Name and Position | Eric Gearing (OWNER) |
Authorized Official Contact | 5737545005 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
122 S 3rd St Louisiana MO 63353-2060 Ph: (573) 754-5005 | 122 S 3rd St Louisiana MO 63353-2060 Ph: (573) 754-5005 |
NPI Number | 1538306642 |
---|---|
Provider Enumeration Date | 01/12/2009 |
Last Update Date | 10/09/2012 |
Medicare PECOS PAC ID | 0941326474 |
---|---|
Medicare Enrollment ID | O20100922000198 |
Identifier | Type | State | Issuer |
---|---|---|---|
1538306642 | NPI | - | NPPES |
1083704852 | Other | MO | NPI |
1972587574 | Other | NPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | 2001022068 (Missouri) | Secondary |
111N00000X | Chiropractor | 006761 (Missouri) | Primary |
Provider Name | Eric Todd Gearing |
---|---|
Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1972587574 PECOS PAC ID: 1850417387 Enrollment ID: I20100922000217 |