Provider Demographics
NPI:1689707408
Name:BIERLY, GREGORY REMY (CHIROPRACTIC DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:REMY
Last Name:BIERLY
Suffix:
Gender:M
Credentials:CHIROPRACTIC DC
Other - Prefix:DR
Other - First Name:GREGORY
Other - Middle Name:R
Other - Last Name:BIERLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:1169 EASTERN PARKWAY
Mailing Address - Street 2:ROOM 2215
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217
Mailing Address - Country:US
Mailing Address - Phone:502-458-0542
Mailing Address - Fax:
Practice Address - Street 1:1169 EASTERN PARKWAY
Practice Address - Street 2:ROOM 2215
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217
Practice Address - Country:US
Practice Address - Phone:502-458-0542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T441OtherBLUE CROSS BLUE SHIELD