Healthcare Provider Details

I. General information

NPI: 1902969082
Provider Name (Legal Business Name): PAUL S GREGORY DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 NORTH TUSTIN AVE #E
SANTA ANA CA
92705-3827
US

IV. Provider business mailing address

310 NORTH TUSTIN AVE #E
SANTA ANA CA
92705-3827
US

V. Phone/Fax

Practice location:
  • Phone: 714-541-0400
  • Fax: 714-541-0110
Mailing address:
  • Phone: 714-541-0400
  • Fax: 714-541-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC16397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: