Provider Demographics
NPI:1609927284
Name:SOMERVILLE, GREGORY BRIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:BRIAN
Last Name:SOMERVILLE
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 1:129 E ST NW
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-4505
Mailing Address - Country:US
Mailing Address - Phone:580-224-9091
Mailing Address - Fax:580-224-9048
Practice Address - Street 1:129 E ST NW
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-4505
Practice Address - Country:US
Practice Address - Phone:580-224-9091
Practice Address - Fax:580-224-9048
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3435111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU-71811Medicare UPIN
231328406Medicare ID - Type Unspecified