Provider Demographics
NPI:1609826932
Name:ANDERSON, GREGORY PAUL (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PAUL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2102 OTRANTO BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9841
Mailing Address - Country:US
Mailing Address - Phone:843-572-5100
Mailing Address - Fax:843-572-5112
Practice Address - Street 1:2102 OTRANTO BLVD
Practice Address - Street 2:STE A
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9841
Practice Address - Country:US
Practice Address - Phone:843-569-2225
Practice Address - Fax:843-569-2225
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2046111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor