Provider Demographics
NPI:1609829266
Name:KOORS, GREGORY F (DC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:F
Last Name:KOORS
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 1:2201 WILLAMETTE STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3091
Mailing Address - Country:US
Mailing Address - Phone:541-683-5678
Mailing Address - Fax:541-343-7350
Practice Address - Street 1:2201 WILLAMETTE STREET
Practice Address - Street 2:SUITE C
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3091
Practice Address - Country:US
Practice Address - Phone:541-683-5678
Practice Address - Fax:541-343-7350
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
117689Medicare ID - Type Unspecified
V02960Medicare UPIN