Provider Demographics
NPI:1053460147
Name:KLEAR, GREGG P (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:P
Last Name:KLEAR
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 1:1010 NORTH DALMONT
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-5218
Mailing Address - Country:US
Mailing Address - Phone:505-393-4636
Mailing Address - Fax:505-393-6927
Practice Address - Street 1:1010 NORTH DALMONT
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-5218
Practice Address - Country:US
Practice Address - Phone:505-393-4636
Practice Address - Fax:505-393-6927
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM$$$$$$$$$Medicare PIN
U89693Medicare UPIN