Provider Demographics
NPI:1750397667
Name:GEHLSEN, JEFFREY P (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:P
Last Name:GEHLSEN
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 1:630 TERRA WEST DR
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-4536
Mailing Address - Country:US
Mailing Address - Phone:815-235-7858
Mailing Address - Fax:815-235-7913
Practice Address - Street 1:630 TERRA WEST DR
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-4536
Practice Address - Country:US
Practice Address - Phone:815-235-7858
Practice Address - Fax:815-235-7913
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-005597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
755470Medicare ID - Type Unspecified
T38572Medicare UPIN
R01879Medicare PIN