Provider Demographics
NPI:1457368763
Name:MCDONALD, GREGOR A (DC)
Entity Type:Individual
Prefix:
First Name:GREGOR
Middle Name:A
Last Name:MCDONALD
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 1:525 EAST 38TH STREET
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1602
Mailing Address - Country:US
Mailing Address - Phone:563-386-4434
Mailing Address - Fax:563-386-5306
Practice Address - Street 1:525 EAST 38TH STREET
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1602
Practice Address - Country:US
Practice Address - Phone:563-386-4434
Practice Address - Fax:563-386-5306
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAC49301OtherJOHN DEERE
IA0167783Medicaid
IAT00990Medicare UPIN
IA0167783Medicaid