Provider Demographics
NPI:1023123981
Name:KORUM, GREGG S (DC)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:S
Last Name:KORUM
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 1:9835 LAKE WORTH RD STE 14
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2368
Mailing Address - Country:US
Mailing Address - Phone:561-642-6400
Mailing Address - Fax:561-642-8198
Practice Address - Street 1:9835 LAKE WORTH RD STE 14
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2368
Practice Address - Country:US
Practice Address - Phone:561-642-6400
Practice Address - Fax:561-642-8198
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6605111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL55133Medicare ID - Type UnspecifiedMEDICARE
U48874Medicare UPIN