Provider Demographics
NPI:1326115072
Name:GAVRIC, GREGORY D (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:D
Last Name:GAVRIC
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 1:7003 S HOWELL AVE STE 1300
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-1402
Mailing Address - Country:US
Mailing Address - Phone:414-762-8626
Mailing Address - Fax:414-762-8765
Practice Address - Street 1:7003 S HOWELL AVE STE 1300
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154
Practice Address - Country:US
Practice Address - Phone:414-762-8626
Practice Address - Fax:414-762-8765
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2141111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38840600Medicaid
WI35672Medicare ID - Type Unspecified
WI38840600Medicaid