Provider Demographics
NPI:1881732592
Name:GREGORY A. CHERNEY, D.C. PROFESSIONAL CHIROPRACTIC CORPORATION
Entity type:Organization
Organization Name:GREGORY A. CHERNEY, D.C. PROFESSIONAL CHIROPRACTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR OF CHIROPRACTIC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:949-315-1313
Mailing Address - Street 1:24953 PASEO DE VALENCIA
Mailing Address - Street 2:22A
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4342
Mailing Address - Country:US
Mailing Address - Phone:949-315-1313
Mailing Address - Fax:
Practice Address - Street 1:15550 ROCKFIELD BLVD
Practice Address - Street 2:B220
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2720
Practice Address - Country:US
Practice Address - Phone:949-598-9999
Practice Address - Fax:949-598-9990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28637111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0286370OtherBLUE SHIELD
CAW20707OtherMEDICARE GROUP
CAWDC28637AMedicare PIN
CAW20707OtherMEDICARE GROUP