Provider Demographics
NPI:1811020555
Name:ENOS, GREGORY D (LAC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
Last Name:ENOS
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2650 WASHBURN WAY
Mailing Address - Street 2:SUITE #180
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-4596
Mailing Address - Country:US
Mailing Address - Phone:541-884-1952
Mailing Address - Fax:541-884-6085
Practice Address - Street 1:2650 WASHBURN WAY
Practice Address - Street 2:SUITE #180
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4596
Practice Address - Country:US
Practice Address - Phone:541-884-1952
Practice Address - Fax:541-884-6085
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC00601171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist