Provider Demographics
NPI:1083036842
Name:NASH, GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:NASH
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 1:331 OAK MANOR DR
Mailing Address - Street 2:STE 101
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5553
Mailing Address - Country:US
Mailing Address - Phone:571-248-0695
Mailing Address - Fax:
Practice Address - Street 1:8006 CRESCENT PARK DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3444
Practice Address - Country:US
Practice Address - Phone:571-248-0695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03952111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor