Provider Demographics
NPI:1457461840
Name:GREGORY, DENNIS D (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:D
Last Name:GREGORY
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 1:4903 SILVER CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-9764
Mailing Address - Country:US
Mailing Address - Phone:573-445-7388
Mailing Address - Fax:573-445-7388
Practice Address - Street 1:4903 SILVER CLIFF DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-9764
Practice Address - Country:US
Practice Address - Phone:573-445-7388
Practice Address - Fax:573-445-7388
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO5290111N00000X
LA724111N00000X
AZ4261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor