Provider Demographics
NPI:1649142761
Name:GERLACH, PETER S (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:GERLACH
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 1:16730 N MARKETPLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-7909
Mailing Address - Country:US
Mailing Address - Phone:208-466-4600
Mailing Address - Fax:
Practice Address - Street 1:16730 N MARKETPLACE BLVD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-7909
Practice Address - Country:US
Practice Address - Phone:208-466-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-18
Last Update Date:2025-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2671778111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor