Basic Information
| Provider Information | |||||||||
| NPI: | 1093268286 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EILERTSON | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1744 E MCANDREWS RD STE D | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975045576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5414140362 | ||||||||
| FaxNumber: | 5412002269 | ||||||||
| Practice Location | |||||||||
| Address1: | 21885 OR-62 | ||||||||
| Address2: | |||||||||
| City: | SHADY COVE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418783603 | ||||||||
| FaxNumber: | 5416228502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2016 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 5728 | OR | Y | Chiropractic Providers | Chiropractor |
ID Information
| ID | Type | State | Issuer | Description | 500787304 | 05 | OR | MEDICAID |