Provider Demographics
NPI:1447041611
Name:GREGG, MALLORIE GRETCHEN (DC)
Entity type:Individual
Prefix:
First Name:MALLORIE
Middle Name:GRETCHEN
Last Name:GREGG
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 1:406 E SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-3762
Mailing Address - Country:US
Mailing Address - Phone:765-362-1111
Mailing Address - Fax:765-362-2609
Practice Address - Street 1:406 E SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-3762
Practice Address - Country:US
Practice Address - Phone:765-362-1111
Practice Address - Fax:765-362-2609
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003515A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor