Provider Demographics
NPI:1205137627
Name:GREGORY, ROBERT (DC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:GREGORY
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 1:1150 N 5TH AVE STE B2
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-1277
Mailing Address - Country:US
Mailing Address - Phone:331-248-0695
Mailing Address - Fax:331-240-1333
Practice Address - Street 1:1150 N 5TH AVE STE B2
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1277
Practice Address - Country:US
Practice Address - Phone:331-248-0695
Practice Address - Fax:331-240-1333
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227011976225700000X
IL038012876111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist