Provider Demographics
NPI:1285097014
Name:SANGREY, GAVIN (DC, MS)
Entity type:Individual
Prefix:
First Name:GAVIN
Middle Name:
Last Name:SANGREY
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CHURCH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-3714
Mailing Address - Country:US
Mailing Address - Phone:978-219-4155
Mailing Address - Fax:
Practice Address - Street 1:30 CHURCH ST STE 204
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3714
Practice Address - Country:US
Practice Address - Phone:978-219-4155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA398776111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor