Provider Demographics
NPI:1255441465
Name:DECRESCENZO, GREGORY (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:DECRESCENZO
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 1:176 TAUNTON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-4533
Mailing Address - Country:US
Mailing Address - Phone:401-435-2002
Mailing Address - Fax:401-435-3553
Practice Address - Street 1:176 TAUNTON AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-4533
Practice Address - Country:US
Practice Address - Phone:401-435-2002
Practice Address - Fax:401-435-3553
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDC395111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU74421Medicare UPIN