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General NPI Number Information
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NPI Number | 1588875462
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Entity Type | Individual
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Provider Name | GREGORY GERALD HAUCK ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 700 CLARK STREET
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City | ST LOUIS
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State | MO
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Zip | 63102-1727
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Country | US
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Telephone | 314-345-9600
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Fax | 314-345-9607
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Provider Business Mailing Address
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Address Line | 410 BALLWIN ESTATES CT
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City | BALLWIN
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State | MO
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Zip | 63021-4992
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Country | US
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Telephone | 636-527-4809
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2005027153
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License Number State | MO
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