Provider Demographics
NPI:1588635676
Name:LODES, GREGG R (DC)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:R
Last Name:LODES
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 1:519 PAPER MILL RD
Mailing Address - Street 2:
Mailing Address - City:ORELAND
Mailing Address - State:PA
Mailing Address - Zip Code:19075-2008
Mailing Address - Country:US
Mailing Address - Phone:215-885-9070
Mailing Address - Fax:215-884-9941
Practice Address - Street 1:519 PAPER MILL RD
Practice Address - Street 2:
Practice Address - City:ORELAND
Practice Address - State:PA
Practice Address - Zip Code:19075-2008
Practice Address - Country:US
Practice Address - Phone:215-885-9070
Practice Address - Fax:215-884-9941
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA002676L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor