Healthcare Provider Details

I. General information

NPI: 1659355139
Provider Name (Legal Business Name): DOUGLAS M. GREGERSON D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

0 S. 630 PRESTON CR
GENEVA IL
60134
US

IV. Provider business mailing address

0 S. 630 PRESTON CR
GENEVA IL
60134
US

V. Phone/Fax

Practice location:
  • Phone: 630-845-0862
  • Fax: 630-578-1018
Mailing address:
  • Phone: 630-845-0862
  • Fax: 630-578-1018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: