Provider Demographics
NPI:1558632323
Name:MASTRONARDE, GREGORY MICHAEL (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:MICHAEL
Last Name:MASTRONARDE
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 1:6425 POST RD
Mailing Address - Street 2:STE 101
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-1215
Mailing Address - Country:US
Mailing Address - Phone:614-653-3989
Mailing Address - Fax:
Practice Address - Street 1:6425 POST RD
Practice Address - Street 2:STE 101
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-1215
Practice Address - Country:US
Practice Address - Phone:614-760-5555
Practice Address - Fax:614-760-5535
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-25
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor