Provider Demographics
NPI:1306010384
Name:CELAYA, GREGORY A (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:CELAYA
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 1:1325 E THOUSAND OAKS BLVD
Mailing Address - Street 2:#104
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-2822
Mailing Address - Country:US
Mailing Address - Phone:805-371-6144
Mailing Address - Fax:
Practice Address - Street 1:1325 E THOUSAND OAKS BLVD
Practice Address - Street 2:#104
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362-2822
Practice Address - Country:US
Practice Address - Phone:805-371-6144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17612111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT18578Medicare UPIN