Provider Demographics
NPI:1942217864
Name:DEMETRIOUS, GREGORY JOSEPH (DC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JOSEPH
Last Name:DEMETRIOUS
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:PO BOX 10863
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28404
Mailing Address - Country:US
Mailing Address - Phone:910-686-5433
Mailing Address - Fax:910-686-6737
Practice Address - Street 1:7491 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411
Practice Address - Country:US
Practice Address - Phone:910-686-5433
Practice Address - Fax:910-686-6737
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2238111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890827FMedicaid
NC890827FMedicaid
2449681Medicare ID - Type Unspecified