Provider Demographics
NPI:1184978538
Name:ST.CLAIR, GREGG R (LAC)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:R
Last Name:ST.CLAIR
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CHELSEA PL
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3216
Mailing Address - Country:US
Mailing Address - Phone:518-383-1230
Mailing Address - Fax:
Practice Address - Street 1:6 CHELSEA PL
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3216
Practice Address - Country:US
Practice Address - Phone:518-383-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001933-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist