Provider Demographics
NPI:1750327680
Name:GITTINS, GREGG G (DC)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:G
Last Name:GITTINS
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 1:565 HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5308
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2704 DELTA OAKS DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-1740
Practice Address - Country:US
Practice Address - Phone:541-484-0360
Practice Address - Fax:541-484-9036
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORU52177Medicare UPIN
OR109569Medicare ID - Type Unspecified