Provider Demographics
NPI:1225101546
Name:WEARSCH, GREGORY STEVEN (DC DOCTOR OF CHIROPR)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:STEVEN
Last Name:WEARSCH
Suffix:
Gender:M
Credentials:DC DOCTOR OF CHIROPR
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 991275
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40269
Mailing Address - Country:US
Mailing Address - Phone:502-491-1815
Mailing Address - Fax:502-671-8435
Practice Address - Street 1:9500 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299
Practice Address - Country:US
Practice Address - Phone:502-491-1815
Practice Address - Fax:502-671-8435
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4232111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85002665Medicaid
KY85002665Medicaid