Provider Demographics
NPI:1790768067
Name:DECAMP, GREGORY ALAN (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:DECAMP
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 1:610 N MISSION ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2065
Mailing Address - Country:US
Mailing Address - Phone:509-662-4711
Mailing Address - Fax:509-662-2800
Practice Address - Street 1:610 N MISSION ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2065
Practice Address - Country:US
Practice Address - Phone:509-662-4711
Practice Address - Fax:509-662-2800
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA115101001Medicare ID - Type Unspecified
WAT02478Medicare UPIN