Provider Demographics
NPI:1922008671
Name:MCDONALD, GREGORY S (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:S
Last Name:MCDONALD
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 1:36945 COOK ST
Mailing Address - Street 2:# 103
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6077
Mailing Address - Country:US
Mailing Address - Phone:760-328-8212
Mailing Address - Fax:760-328-8216
Practice Address - Street 1:36945 COOK ST
Practice Address - Street 2:# 103
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6077
Practice Address - Country:US
Practice Address - Phone:760-328-8212
Practice Address - Fax:760-328-8216
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2014-10-02
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
CADC16732111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00284502OtherRAILROAD MEDICARE PPIN
CADC0167320OtherBLUE SHIELD PROVIDER
CAT06249Medicare UPIN
CADC0167321Medicare PIN
CADC0167320OtherBLUE SHIELD PROVIDER
CADC0167322Medicare PIN