Provider Demographics
NPI:1629153820
Name:CARROLL, GREGORY (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:CARROLL
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 1:3696 GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2906
Mailing Address - Country:US
Mailing Address - Phone:614-801-1307
Mailing Address - Fax:614-277-1363
Practice Address - Street 1:4261 KIMBERLY PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-7226
Practice Address - Country:US
Practice Address - Phone:614-755-7700
Practice Address - Fax:614-755-9634
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3510111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311758335OtherTAX I.D.
OH2521597Medicaid
OHCA4143821Medicare PIN