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General NPI Number Information
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NPI Number | 1528390564
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Entity Type | Organization
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Legal Business Name | GREGORY J. MONGEON, DC, PC
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Dates
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Enumeration Date | 02/02/2010
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Last Update Date | 02/02/2010
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Provider Practice Location Address
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Address Line | 2855 S 70TH ST
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City | LINCOLN
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State | NE
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Zip | 68506-3700
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Country | US
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Telephone | 612-499-1008
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Fax |
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Provider Business Mailing Address
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Address Line | 2508 BORDEAUX LN APT 208
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City | NAPERVILLE
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State | IL
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Zip | 60540-2013
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Country | US
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Telephone | 612-499-1008
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY MONGEON
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Credential | D.C.
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Telephone | 612-499-1008
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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 | 1558
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License Number State | NE
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