Provider Demographics
NPI:1003990904
Name:GEBHART, GREGORY G (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:G
Last Name:GEBHART
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 1:100 N LA SALLE ST
Mailing Address - Street 2:SUITE 812
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2448
Mailing Address - Country:US
Mailing Address - Phone:312-479-2298
Mailing Address - Fax:
Practice Address - Street 1:100 N LA SALLE ST
Practice Address - Street 2:SUITE 812
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2448
Practice Address - Country:US
Practice Address - Phone:312-479-2298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1633792OtherBLUE CROSS BLUE SHIELD
IL658740OtherAMERICAN CHIROPRACTIC NET