Provider Demographics
NPI:1023168390
Name:GREGO, MICHAEL P (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:GREGO
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 1:2170 W POINT RD
Mailing Address - Street 2:STE 5
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4007
Mailing Address - Country:US
Mailing Address - Phone:706-616-6775
Mailing Address - Fax:
Practice Address - Street 1:2170 W POINT RD
Practice Address - Street 2:STE 5
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4007
Practice Address - Country:US
Practice Address - Phone:706-616-6775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIRO02886111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACHIR002886OtherPRACTICE LICENSE
GA27-2178870OtherTAX ID
GA5248447 001OtherBLUE CROSS BLUE SHIELD
GA27-2178870OtherTAX ID