Provider Demographics
NPI:1760533921
Name:GREGOR, JON JUSTIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:JUSTIN
Last Name:GREGOR
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 1:15851 DALLAS PKWY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3369
Mailing Address - Country:US
Mailing Address - Phone:214-561-8644
Mailing Address - Fax:214-561-8645
Practice Address - Street 1:15851 DALLAS PKWY
Practice Address - Street 2:SUITE 600
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3369
Practice Address - Country:US
Practice Address - Phone:214-561-8644
Practice Address - Fax:214-561-8645
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9412111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition