Provider Demographics
NPI:1639218993
Name:POPKIN, GREGG R (DC)
Entity Type:Individual
Prefix:MR
First Name:GREGG
Middle Name:R
Last Name:POPKIN
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 1:4631 NW 31ST AVE
Mailing Address - Street 2:#135
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3433
Mailing Address - Country:US
Mailing Address - Phone:954-486-1377
Mailing Address - Fax:954-486-1374
Practice Address - Street 1:4384 NW 31ST AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-4206
Practice Address - Country:US
Practice Address - Phone:954-486-1377
Practice Address - Fax:943-486-1374
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH-7081111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGM138ZMedicare PIN