Provider Demographics
NPI:1659452738
Name:BREGER, DOUGLAS J (DC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:BREGER
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 1:727 SPECKMAN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40243-1876
Mailing Address - Country:US
Mailing Address - Phone:502-250-2003
Mailing Address - Fax:502-250-2004
Practice Address - Street 1:727 SPECKMAN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1876
Practice Address - Country:US
Practice Address - Phone:502-250-2003
Practice Address - Fax:502-250-2004
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002033A111NR0200X, 111NR0400X
KY288936111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200483400Medicaid
INV00350Medicare UPIN
IN200483400Medicaid