Provider Demographics
NPI:1013922129
Name:GRESHAM, JANNA LEIGH (DC)
Entity Type:Individual
Prefix:DR
First Name:JANNA
Middle Name:LEIGH
Last Name:GRESHAM
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-9613
Mailing Address - Country:US
Mailing Address - Phone:270-465-5200
Mailing Address - Fax:
Practice Address - Street 1:100 GREENBRIAR DR
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9613
Practice Address - Country:US
Practice Address - Phone:270-465-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001788111N00000X
KY5035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4012576OtherBLUE CROSS BLUE SHIELD
KY7100017000Medicaid
TN4012576OtherBLUE CROSS BLUE SHIELD