Provider Demographics
NPI:1952506784
Name:LOGAN, GREGORY BENJAMIN (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:BENJAMIN
Last Name:LOGAN
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 1:3400 BEE RIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-7243
Mailing Address - Country:US
Mailing Address - Phone:941-927-1123
Mailing Address - Fax:941-927-1124
Practice Address - Street 1:3400 BEE RIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-7243
Practice Address - Country:US
Practice Address - Phone:941-927-1123
Practice Address - Fax:941-927-1124
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8424111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL38183490Medicaid
U97821Medicare UPIN
FL38183490Medicaid