Provider Demographics
NPI:1710277389
Name:BOBO, GREGORY EGBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EGBERT
Last Name:BOBO
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 1:3441 LEBANON PIKE
Mailing Address - Street 2:SUITE 117
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076
Mailing Address - Country:US
Mailing Address - Phone:615-871-9000
Mailing Address - Fax:615-871-9018
Practice Address - Street 1:3441 LEBANON PIKE
Practice Address - Street 2:SUITE 117
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076
Practice Address - Country:US
Practice Address - Phone:615-871-9000
Practice Address - Fax:615-871-9018
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008801111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor