Provider Demographics
NPI:1255803094
Name:GREGOIRE, LAUREN (DC)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:GREGOIRE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14728 59TH AVE S
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-4716
Mailing Address - Country:US
Mailing Address - Phone:253-797-3413
Mailing Address - Fax:
Practice Address - Street 1:18008 STATE ROUTE 410 E STE D
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-7113
Practice Address - Country:US
Practice Address - Phone:253-447-8440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-18
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60912539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty