Provider Demographics
NPI:1265501464
Name:GREGORY, KOLLEEN ELIZABETH (DC)
Entity Type:Individual
Prefix:DR
First Name:KOLLEEN
Middle Name:ELIZABETH
Last Name:GREGORY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 W MOUNTAIN ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-2967
Mailing Address - Country:US
Mailing Address - Phone:626-449-0900
Mailing Address - Fax:626-449-0800
Practice Address - Street 1:236 W MOUNTAIN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-2967
Practice Address - Country:US
Practice Address - Phone:626-449-0900
Practice Address - Fax:626-449-0800
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29435111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor