Provider Demographics
NPI:1851309520
Name:GREGORY, MATTHEW (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:GREGORY
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 1:611 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-3151
Mailing Address - Country:US
Mailing Address - Phone:704-829-9200
Mailing Address - Fax:704-829-5700
Practice Address - Street 1:611 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3151
Practice Address - Country:US
Practice Address - Phone:704-829-9200
Practice Address - Fax:704-829-5700
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2333111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890826XMedicaid
NC0826XMedicare UPIN
NC2450388Medicare ID - Type Unspecified