Provider Demographics
NPI:1508986894
Name:MESS, GREG MARVIN (DC)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:MARVIN
Last Name:MESS
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:PO BOX 107
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-0107
Mailing Address - Country:US
Mailing Address - Phone:208-452-3352
Mailing Address - Fax:208-452-3355
Practice Address - Street 1:2210 N WHITLEY DR
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2131
Practice Address - Country:US
Practice Address - Phone:208-452-3352
Practice Address - Fax:208-452-3355
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHII833111N00000X
OR273040111N00000X
IDCHIA833111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR102092Medicare ID - Type Unspecified