Provider Demographics
NPI:1790927036
Name:GREGORY, AMIE BETH (DC)
Entity Type:Individual
Prefix:
First Name:AMIE
Middle Name:BETH
Last Name:GREGORY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1902
Mailing Address - Country:US
Mailing Address - Phone:650-353-1133
Mailing Address - Fax:
Practice Address - Street 1:838 MAIN STREET
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-4121
Practice Address - Country:US
Practice Address - Phone:650-353-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31182111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor