Provider Demographics
NPI:1578630505
Name:LIND, GREGORY A (DC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:A
Last Name:LIND
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 1:1778 CLEAR LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-7014
Mailing Address - Country:US
Mailing Address - Phone:408-263-8025
Mailing Address - Fax:408-263-8026
Practice Address - Street 1:1778 CLEAR LAKE AVE
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-7014
Practice Address - Country:US
Practice Address - Phone:408-263-8025
Practice Address - Fax:408-263-8026
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC0159920111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATO5978Medicare UPIN