Provider Demographics
NPI:1689727810
Name:BINDL, GREGORY ALLAN (DC)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ALLAN
Last Name:BINDL
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 1:2121 NEW PINERY ROAD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901
Mailing Address - Country:US
Mailing Address - Phone:608-743-4300
Mailing Address - Fax:
Practice Address - Street 1:2121NEW PINERY RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901
Practice Address - Country:US
Practice Address - Phone:608-742-4300
Practice Address - Fax:608-742-4311
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4265-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor