Healthcare Provider Details

I. General information

NPI: 1053460147
Provider Name (Legal Business Name): GREGG P KLEAR DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 NORTH DALMONT
HOBBS NM
88240-5218
US

IV. Provider business mailing address

1010 NORTH DALMONT
HOBBS NM
88240-5218
US

V. Phone/Fax

Practice location:
  • Phone: 505-393-4636
  • Fax: 505-393-6927
Mailing address:
  • Phone: 505-393-4636
  • Fax: 505-393-6927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1541
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: