Provider Demographics
NPI:1093892077
Name:GREGORY CHIROPRACTIC CENTER PA
Entity Type:Organization
Organization Name:GREGORY CHIROPRACTIC CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-829-9200
Mailing Address - Street 1:611 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3151
Mailing Address - Country:US
Mailing Address - Phone:704-829-9200
Mailing Address - Fax:704-829-5700
Practice Address - Street 1:611 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3151
Practice Address - Country:US
Practice Address - Phone:704-829-9200
Practice Address - Fax:704-829-5700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2333111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890826XMedicaid
NC2450388Medicare ID - Type Unspecified
NC890826XMedicaid