Healthcare Provider Details

I. General information

NPI: 1699840496
Provider Name (Legal Business Name): ROGER M GREGORY III DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5604 I 55 SOUTH GREGORY CHIROPRACTIC CENTER
BYRAM MS
39272
US

IV. Provider business mailing address

5604 I 55 SOUTH GREGORY CHIROPRACTIC CENTER
BYRAM MS
39272
US

V. Phone/Fax

Practice location:
  • Phone: 601-373-5767
  • Fax: 601-372-4031
Mailing address:
  • Phone: 601-373-5767
  • Fax: 601-372-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number589
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: