MEDICARE: DR. GREGORY BRIGOLA D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CH10194	FL

General Provider Information

NPI Number	:	1750685954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY BRIGOLA D.C.

Provider Business Mailing Address
First Line	:	672 BERT KOUNS INDUSTRIAL LOOP
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71118
Country	:	US
Telephone Number	:	318-686-3152
Fax Number	:	318-688-5846

Provider Business Practice Location Address
First Line	:	4626 S CLYDE MORRIS BLVD STE 1
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32129-6402
Country	:	US
Telephone Number	:	386-523-1300
Fax Number	:	386-523-0944

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2011
Last Update Date	:	06/04/2018

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