Provider Demographics
NPI:1366447500
Name:MCGREGOR, NICHOLAS JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JAMES
Last Name:MCGREGOR
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 S OAK AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3957
Mailing Address - Country:US
Mailing Address - Phone:507-455-0199
Mailing Address - Fax:507-455-9224
Practice Address - Street 1:1414 S OAK AVE
Practice Address - Street 2:STE 4
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-3957
Practice Address - Country:US
Practice Address - Phone:507-455-0199
Practice Address - Fax:507-455-9224
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN002168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN86706MCOtherBLUE CROSS BLUE SHIELD MN
MN1366447500Medicaid
MN1366447500Medicaid
MN86706MCOtherBLUE CROSS BLUE SHIELD MN