Provider Demographics
NPI:1093878779
Name:GREGORY CHIROPRACTIC HEALTH CENTER P.C.
Entity Type:Organization
Organization Name:GREGORY CHIROPRACTIC HEALTH CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:276-889-4701
Mailing Address - Street 1:PO BOX 2425
Mailing Address - Street 2:1114 E MAIN SUITE 7
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-2425
Mailing Address - Country:US
Mailing Address - Phone:276-889-4701
Mailing Address - Fax:276-889-4701
Practice Address - Street 1:1114 E MAIN ST
Practice Address - Street 2:SUITE 7
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-5014
Practice Address - Country:US
Practice Address - Phone:276-889-4701
Practice Address - Fax:276-889-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2011-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA332447OtherANTHEM