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General NPI Number Information
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NPI Number | 1154735710
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Entity Type | Individual
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Provider Name | GREGORY SCOTT STAYBERG D.C.
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Gender | Male
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 1870 WESTWOOD BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90025-4612
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Country | US
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Telephone | 213-515-5151
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Fax |
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Provider Business Mailing Address
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Address Line | 13020 ARDATH AVE
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City | GARDENA
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State | CA
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Zip | 90249-1525
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Country | US
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Telephone | 310-650-1104
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 34271
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License Number State | CA
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