Provider Demographics
NPI:1790871929
Name:SALLANS, GREGORY NEAL (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:NEAL
Last Name:SALLANS
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 1:919 16TH ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NE
Mailing Address - Zip Code:68818-2433
Mailing Address - Country:US
Mailing Address - Phone:402-694-6565
Mailing Address - Fax:402-694-3563
Practice Address - Street 1:919 16TH ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:NE
Practice Address - Zip Code:68818-2433
Practice Address - Country:US
Practice Address - Phone:402-694-6565
Practice Address - Fax:402-694-3563
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-0614839-00Medicaid
NE47-0614839-00Medicaid
NE273822Medicare ID - Type Unspecified