Provider Demographics
NPI:1174030688
Name:GREGORY, DOUGLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:GREGORY
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 1:2588 N 500 W
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:UT
Mailing Address - Zip Code:84015-2575
Mailing Address - Country:US
Mailing Address - Phone:385-288-0934
Mailing Address - Fax:
Practice Address - Street 1:736 W RIVERDALE ROAD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:UT
Practice Address - Zip Code:84405-3715
Practice Address - Country:US
Practice Address - Phone:385-288-0934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10638431-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT82-1177345OtherFEIN