Provider Demographics
NPI:1972502250
Name:GREGORY, NELSON FISHER (DC)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:FISHER
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 1:2901 STONEWALL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-3554
Mailing Address - Country:US
Mailing Address - Phone:804-814-3545
Mailing Address - Fax:804-977-1301
Practice Address - Street 1:5317 A LAKESIDE AVE
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228
Practice Address - Country:US
Practice Address - Phone:804-303-4961
Practice Address - Fax:804-912-2366
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000707111N00000X, 111NS0005X, 111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00V726C06Medicare PIN
VAU13416Medicare UPIN