Provider Demographics
NPI:1710058268
Name:GREGERSON CHIROPRACTIC PC
Entity Type:Organization
Organization Name:GREGERSON CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:DODD
Authorized Official - Last Name:GREGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-362-3601
Mailing Address - Street 1:1520 MIDLAND CT NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-8404
Mailing Address - Country:US
Mailing Address - Phone:319-362-3601
Mailing Address - Fax:319-362-3610
Practice Address - Street 1:1520 MIDLAND CT NE
Practice Address - Street 2:SUITE 100
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-8404
Practice Address - Country:US
Practice Address - Phone:319-362-3601
Practice Address - Fax:319-362-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05804111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI14835Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER