Provider Demographics
NPI:1619642899
Name:POMA, GREGORY (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:POMA
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 1:107 W GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-2236
Mailing Address - Country:US
Mailing Address - Phone:517-518-8963
Mailing Address - Fax:517-518-8735
Practice Address - Street 1:107 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-2236
Practice Address - Country:US
Practice Address - Phone:517-518-8963
Practice Address - Fax:517-518-8735
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301011095111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor