Individual
GERRIT VAN LOON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
103 SHARLENE RD, ITHACA, NY 14850-6315
(607) 277-1468
(607) 277-1468
Mailing address
103 SHARLENE RD, ITHACA, NY 14850-6315
(607) 277-1468
(607) 277-1468
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
006650
NY
225100000X
Physical Therapist
8425
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000916364001
HEALTH NEW - CHIRO
NY
Enumeration date
04/02/2007
Last updated
07/18/2024
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