Provider Demographics
NPI:1457837650
Name:GREGORY, JEFFREY TYLER (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:TYLER
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 1:323 AIRPORT RD STE C
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5701
Mailing Address - Country:US
Mailing Address - Phone:334-212-0101
Mailing Address - Fax:
Practice Address - Street 1:15600 PANAMA CITY BEACH PKWY UNIT 700
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32413-5430
Practice Address - Country:US
Practice Address - Phone:334-212-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-11
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12515111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty