Healthcare Provider Details

I. General information

NPI: 1609829266
Provider Name (Legal Business Name): GREGORY F. KOORS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 WILLAMETTE STREET SUITE C
EUGENE OR
97405-3091
US

IV. Provider business mailing address

2201 WILLAMETTE STREET SUITE C
EUGENE OR
97405-3091
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-5678
  • Fax: 541-343-7350
Mailing address:
  • Phone: 541-683-5678
  • Fax: 541-343-7350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2657
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: