Provider Demographics
NPI:1881766426
Name:GREGORY CHIROPRACTIC INC
Entity type:Organization
Organization Name:GREGORY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GREGROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-864-6519
Mailing Address - Street 1:11201 88TH AVE E
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3802
Mailing Address - Country:US
Mailing Address - Phone:253-864-6519
Mailing Address - Fax:253-864-0673
Practice Address - Street 1:11201 88TH AVE E
Practice Address - Street 2:SUITE 120
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3802
Practice Address - Country:US
Practice Address - Phone:253-864-6519
Practice Address - Fax:253-864-0673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003156111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00158090OtherMEDICARE RAILROAD
WA135018OtherLABOR AND INDUSTRIES
WAGAB32089Medicare ID - Type Unspecified
WAP00158090OtherMEDICARE RAILROAD