MEDICARE: DR. MARK VICTOR GREGG D.C., P.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	4455	AZ

General Provider Information

NPI Number	:	1952379687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK VICTOR GREGG D.C., P.C.

Provider Business Mailing Address
First Line	:	2303 N 44TH ST
Second Line	:	SUITE 15
City	:	PHOENIX
State	:	AZ
Zip	:	85008-2442
Country	:	US
Telephone Number	:	602-840-3351
Fax Number	:	602-840-3351

Provider Business Practice Location Address
First Line	:	2303 N 44TH ST
Second Line	:	SUITE 15
City	:	PHOENIX
State	:	AZ
Zip	:	85008-2442
Country	:	US
Telephone Number	:	602-840-3351
Fax Number	:	602-840-3351

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	02/01/2008

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