Provider Demographics
NPI:1619017985
Name:SUMMERS, GREGORY R (LMP, DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:R
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:LMP, 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 SW 356TH ST
Mailing Address - Street 2:STE. A
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-3033
Mailing Address - Country:US
Mailing Address - Phone:253-838-1441
Mailing Address - Fax:253-838-4345
Practice Address - Street 1:2201 SW 356TH ST
Practice Address - Street 2:STE. A
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-3033
Practice Address - Country:US
Practice Address - Phone:253-838-1441
Practice Address - Fax:253-838-4345
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034210111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2158SUOtherREGENCE RIDER
WA2158SUOtherREGENCE RIDER
WAV03705Medicare UPIN