Provider Demographics
NPI:1629064464
Name:SHIRK, GREGORY J (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:SHIRK
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 1:630 1ST ST NW
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2947
Mailing Address - Country:US
Mailing Address - Phone:641-423-4455
Mailing Address - Fax:641-423-0354
Practice Address - Street 1:630 1ST ST NW
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2947
Practice Address - Country:US
Practice Address - Phone:641-423-4455
Practice Address - Fax:641-423-0354
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05882111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0121657Medicaid
IA59606OtherBCBS
IA0121657Medicaid