Provider Demographics
NPI:1376627455
Name:GAMACHE, GREGORY PAUL (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:PAUL
Last Name:GAMACHE
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 1:8301 DAYTON PIKE
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-4202
Mailing Address - Country:US
Mailing Address - Phone:423-842-2828
Mailing Address - Fax:423-842-1688
Practice Address - Street 1:8301 DAYTON PIKE
Practice Address - Street 2:
Practice Address - City:SODDY DAISY
Practice Address - State:TN
Practice Address - Zip Code:37379-4202
Practice Address - Country:US
Practice Address - Phone:423-842-2828
Practice Address - Fax:423-842-1688
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1885111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0624970OtherCIGNA ID
TN7582414OtherAETNA ID
TN4051204OtherBLUE CROSS BLUE SHIELD
TNP00030062OtherPALMETTO MEDICARE RAILROA
TN4051204OtherBLUE CROSS BLUE SHIELD
TN7582414OtherAETNA ID