Provider Demographics
NPI:1174670905
Name:DABB, GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:DABB
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 1:4546 EL CAMINO REAL
Mailing Address - Street 2:SUITE B2
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-3031
Mailing Address - Country:US
Mailing Address - Phone:650-949-0154
Mailing Address - Fax:650-949-1045
Practice Address - Street 1:4546 EL CAMINO REAL
Practice Address - Street 2:SUITE B2
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-3031
Practice Address - Country:US
Practice Address - Phone:650-949-0154
Practice Address - Fax:650-949-1045
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26952111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC26952OtherSTATE LICENSE #