Individual
DR. MICHAEL JAMES GERGOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
130 3RD ST, LA SALLE, IL 61301-2312
(815) 223-0647
(815) 223-0987
Mailing address
130 3RD ST, LA SALLE, IL 61301-2312
(815) 223-0647
(815) 223-0987
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038011831
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619267135
CHIROPRACTOR
IL
Enumeration date
02/15/2011
Last updated
10/16/2018
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