Individual
DR. GERARD GORDON HOFFERTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
826 W EDISON RD, MISHAWAKA, IN 46545-2744
(574) 256-1008
Mailing address
PO BOX 6206, SOUTH BEND, IN 46660-6206
(574) 256-1008
(574) 256-9088
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001419
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000089658
BLUE CROSS BLUE SHIELD ID
IN
05
—
100093260A
—
IN
01
—
5547648
AETNA ID#
IN
Enumeration date
03/27/2007
Last updated
10/24/2016
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