Provider Demographics
NPI:1346633591
Name:GREGORY, AMBER DAWN DEPASQUALE (DC CCSP)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:DAWN DEPASQUALE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:DC CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 FM 2920 RD STE 502
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-3687
Mailing Address - Country:US
Mailing Address - Phone:281-541-4820
Mailing Address - Fax:346-331-6786
Practice Address - Street 1:4750 FM 2920 RD STE 502
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388
Practice Address - Country:US
Practice Address - Phone:281-541-4820
Practice Address - Fax:346-331-6786
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-12
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12859111NS0005X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician