Provider Demographics
NPI:1194388959
Name:GREGORY, JUSTIN MATTHEW (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MATTHEW
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 1:14 WHEATMILL CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4301
Mailing Address - Country:US
Mailing Address - Phone:636-358-8607
Mailing Address - Fax:
Practice Address - Street 1:225 VIOLYN DR
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-8128
Practice Address - Country:US
Practice Address - Phone:417-334-6660
Practice Address - Fax:417-334-6661
Is Sole Proprietor?:No
Enumeration Date:2019-04-17
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019012253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor