Provider Demographics
NPI:1588840623
Name:FAVEREAU, GREGG G (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:G
Last Name:FAVEREAU
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:GREG
Other - Middle Name:G
Other - Last Name:BRANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:10910 STATE ROAD 70 E STE 101
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-8406
Mailing Address - Country:US
Mailing Address - Phone:941-799-7207
Mailing Address - Fax:941-799-2077
Practice Address - Street 1:10910 STATE ROAD 70 E STE 101
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-8406
Practice Address - Country:US
Practice Address - Phone:941-749-7207
Practice Address - Fax:941-799-2077
Is Sole Proprietor?:No
Enumeration Date:2008-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 9446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor