Provider Demographics
NPI:1437333085
Name:GREGORY CHIROPRACTIC CENTER, PSC
Entity Type:Organization
Organization Name:GREGORY CHIROPRACTIC CENTER, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-449-1270
Mailing Address - Street 1:3934 DIXIE HWY
Mailing Address - Street 2:STE 505
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4163
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:502-449-1271
Practice Address - Street 1:3934 DIXIE HWY
Practice Address - Street 2:STE 505
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-4163
Practice Address - Country:US
Practice Address - Phone:502-449-1270
Practice Address - Fax:502-449-1271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty