Provider Demographics
NPI:1982633665
Name:COHANE, GREGORY B (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:B
Last Name:COHANE
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 1:12630 EAGLE POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-7920
Mailing Address - Country:US
Mailing Address - Phone:239-910-0990
Mailing Address - Fax:239-489-4840
Practice Address - Street 1:15250 S TAMIAMI TRL
Practice Address - Street 2:REGAL PLAZA
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-7222
Practice Address - Country:US
Practice Address - Phone:239-489-4400
Practice Address - Fax:239-489-4840
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006603111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU43537Medicare UPIN
FL22898Medicare ID - Type UnspecifiedMEDICARE