Provider Demographics
NPI:1023058039
Name:FROST, GREGORY P (DC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:P
Last Name:FROST
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 1:7631 NUEVA CASTILLA WAY
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8139
Mailing Address - Country:US
Mailing Address - Phone:760-720-0777
Mailing Address - Fax:760-720-2930
Practice Address - Street 1:3144 EL CAMINO REAL
Practice Address - Street 2:201
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2194
Practice Address - Country:US
Practice Address - Phone:760-720-0777
Practice Address - Fax:760-720-2930
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC18092OtherSTATE LICENSE
CAT18657Medicare UPIN