Provider Demographics
NPI:1366764219
Name:STEPHEN F GEDERS, DC, PC
Entity type:Organization
Organization Name:STEPHEN F GEDERS, DC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:GEDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-356-1212
Mailing Address - Street 1:1504 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-1401
Mailing Address - Country:US
Mailing Address - Phone:260-356-1212
Mailing Address - Fax:260-358-4603
Practice Address - Street 1:1504 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-1401
Practice Address - Country:US
Practice Address - Phone:260-356-1212
Practice Address - Fax:260-358-4603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001152111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN265450OtherMEDICARE PTAN
IN100138330Medicaid