Provider Demographics
NPI:1134692973
Name:MENDIAZ, GREGORY S (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:S
Last Name:MENDIAZ
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:PO BOX 720681
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73172-0681
Mailing Address - Country:US
Mailing Address - Phone:405-200-1931
Mailing Address - Fax:405-200-1623
Practice Address - Street 1:7301 BROADWAY EXT STE 102
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9038
Practice Address - Country:US
Practice Address - Phone:405-200-1931
Practice Address - Fax:405-200-1623
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor