Provider Demographics
NPI:1053309161
Name:GREGORY D. MONROE, CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:GREGORY D. MONROE, CHIROPRACTIC, INC.
Other - Org Name:MONROE CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:SUTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-592-3124
Mailing Address - Street 1:511 W VISALIA RD
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-1019
Mailing Address - Country:US
Mailing Address - Phone:559-592-3124
Mailing Address - Fax:559-592-2457
Practice Address - Street 1:511 W VISALIA RD
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-1019
Practice Address - Country:US
Practice Address - Phone:559-592-3124
Practice Address - Fax:559-592-2457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ04559ZOtherMEDICARE PTAN
CAZZZ04559ZOtherMEDICARE PTAN