Provider Demographics
NPI:1770676421
Name:HOUGH, GREGORY J (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:HOUGH
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 1:4771 TRIER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-4968
Mailing Address - Country:US
Mailing Address - Phone:260-492-8300
Mailing Address - Fax:260-492-8301
Practice Address - Street 1:4771 TRIER ROAD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815
Practice Address - Country:US
Practice Address - Phone:260-492-8300
Practice Address - Fax:260-492-8301
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200949240AMedicaid
IN100081330AMedicaid
INT83587Medicare UPIN
IN200949240AMedicaid