Provider Demographics
NPI:1538139829
Name:PAGE, GREGORY EUGENE (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EUGENE
Last Name:PAGE
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 1:1690 15TH ST
Mailing Address - Street 2:P.O. BOX 2296
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-9431
Mailing Address - Country:US
Mailing Address - Phone:541-997-6909
Mailing Address - Fax:541-997-5212
Practice Address - Street 1:1690 15TH ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-9431
Practice Address - Country:US
Practice Address - Phone:541-997-6909
Practice Address - Fax:541-997-5212
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR350013574OtherRR MEDICARE #
OR048777000OtherBLUE CROSS/BLUE SHIELD
ORR0000QGDDJMedicare PIN
OR048777000OtherBLUE CROSS/BLUE SHIELD