MEDICARE: GREGG CHIROPRACTIC LIFE CENTER 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	6693110001	OTHER	MI	DMEPOS

General Provider Information

NPI Number	:	1992865703
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGG CHIROPRACTIC LIFE CENTER P.C.

Provider Business Mailing Address
First Line	:	1647 INKSTER RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-3086
Country	:	US
Telephone Number	:	734-525-8422
Fax Number	:	734-525-5421

Provider Business Practice Location Address
First Line	:	1647 INKSTER RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-3086
Country	:	US
Telephone Number	:	734-525-8422
Fax Number	:	734-525-5421

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROBERT JAMES GREGG
Credential	:	D.C.
Telephone Number	:	734-525-8422

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	02/01/2013

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