Provider Demographics
NPI:1225049778
Name:GREGORY, BARRY KEITH (DC)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:KEITH
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:PO BOX 2425
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-2425
Mailing Address - Country:US
Mailing Address - Phone:276-889-4701
Mailing Address - Fax:276-889-4701
Practice Address - Street 1:1114 E. MAIN STREET
Practice Address - Street 2:SUITE 7
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266
Practice Address - Country:US
Practice Address - Phone:276-889-4701
Practice Address - Fax:276-889-4701
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000589111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA332447OtherANTHEM
VAT21438Medicare UPIN
VA350000214Medicare PIN