Provider Demographics
NPI:1568552768
Name:HAWTHORNE, GREGORY ALLEN (DC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ALLEN
Last Name:HAWTHORNE
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 1:136 FURMAN RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5038
Mailing Address - Country:US
Mailing Address - Phone:828-264-4521
Mailing Address - Fax:828-264-1380
Practice Address - Street 1:136 FURMAN RD
Practice Address - Street 2:SUITE #1
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5038
Practice Address - Country:US
Practice Address - Phone:828-264-4521
Practice Address - Fax:828-264-1380
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1269111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08489OtherBCBS PROVIDER #
NC244355AMedicare ID - Type Unspecified