Provider Demographics
NPI:1134155237
Name:HIGHSMITH, GREGORY D (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:D
Last Name:HIGHSMITH
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 1:2426 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-1326
Mailing Address - Country:US
Mailing Address - Phone:812-482-6133
Mailing Address - Fax:812-482-1581
Practice Address - Street 1:2426 NEWTON ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1326
Practice Address - Country:US
Practice Address - Phone:812-482-6133
Practice Address - Fax:812-482-1581
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000576A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100109100AMedicaid
IN100109100AMedicaid
IN25095Medicare UPIN