Provider Demographics
NPI:1205845955
Name:UNGERANK, GREGORY ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALLEN
Last Name:UNGERANK
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 1:711 EAST ELDRIDGE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-4032
Mailing Address - Country:US
Mailing Address - Phone:870-238-8210
Mailing Address - Fax:870-238-8210
Practice Address - Street 1:711 ELDRIDGE AVE E
Practice Address - Street 2:SUITE A
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-4032
Practice Address - Country:US
Practice Address - Phone:870-238-8210
Practice Address - Fax:870-238-8210
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1179111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR59693Medicare UPIN
59693Medicare ID - Type Unspecified