Healthcare Provider Details

I. General information

NPI: 1053309161
Provider Name (Legal Business Name): GREGORY D. MONROE, CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W VISALIA RD
EXETER CA
93221-1019
US

IV. Provider business mailing address

511 W VISALIA RD
EXETER CA
93221-1019
US

V. Phone/Fax

Practice location:
  • Phone: 559-592-3124
  • Fax: 559-592-2457
Mailing address:
  • Phone: 559-592-3124
  • Fax: 559-592-2457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MRS. NANCY LOU SUTA
Title or Position: MANAGER
Credential:
Phone: 559-592-3124