Provider Demographics
NPI:1851471346
Name:GREGORY, DARRYL R (DC)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:R
Last Name:GREGORY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3198 CUSTER DR STE 100
Mailing Address - Street 2:SOUTHSIDE CHIROPRACTIC PSC
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4000
Mailing Address - Country:US
Mailing Address - Phone:859-373-0800
Mailing Address - Fax:859-255-4104
Practice Address - Street 1:3198 CUSTER DR STE 100
Practice Address - Street 2:SOUTHSIDE CHIROPRACTIC PSC
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4000
Practice Address - Country:US
Practice Address - Phone:859-373-0800
Practice Address - Fax:859-255-4104
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4626111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85002269Medicaid
KY000000209773OtherBCBS
KY000000209773OtherBCBS
KY85002269Medicaid