Provider Demographics
NPI:1851394860
Name:STERN, GREGG (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:
Last Name:STERN
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 1:121 MCHENRY RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1796
Mailing Address - Country:US
Mailing Address - Phone:847-537-2225
Mailing Address - Fax:847-537-2226
Practice Address - Street 1:121 MCHENRY RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1796
Practice Address - Country:US
Practice Address - Phone:847-537-2225
Practice Address - Fax:847-537-2226
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-09-16
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
IL038-009-281111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL647030Medicare ID - Type Unspecified
ILU84190Medicare UPIN