Provider Demographics
NPI:1689125791
Name:GREGORY, JOAN MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:GREGORY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 MEDICAL CENTRE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4757
Mailing Address - Country:US
Mailing Address - Phone:817-276-0044
Mailing Address - Fax:
Practice Address - Street 1:909 MEDICAL CENTRE DR
Practice Address - Street 2:SUITE B
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4757
Practice Address - Country:US
Practice Address - Phone:817-276-0044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00593171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist