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1750685954 NPI number — GREGORY BRIGOLA D.C.

NPI Number: 1750685954
Health Care Provider/Practitioner: GREGORY BRIGOLA D.C.

Information about “1750685954” NPI (GREGORY BRIGOLA D.C.) exists in 1750685954 in HTML format HTML  |  1750685954 in plain Text format TXT  |  1750685954 in PDF (Portable Document Format) PDF  |  1750685954 in an XML format XML  formats.

NPI Number : 1750685954 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1750685954",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRIGOLA",
    "FirstName": "GREGORY",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "D.C.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "672 BERT KOUNS INDUSTRIAL LOOP",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SHREVEPORT",
    "MailingAddressStateName": "LA",
    "MailingAddressPostalCode": "71118",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "318-686-3152",
    "MailingAddressFaxNumber": "318-688-5846",
    "FirstLinePracticeLocationAddress": "4626 S CLYDE MORRIS BLVD STE 1",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORT ORANGE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32129-6402",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "386-523-1300",
    "PracticeLocationAddressFaxNumber": "386-523-0944",
    "EnumerationDate": "01/02/2011",
    "LastUpdateDate": "06/04/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "111N00000X",
        "TaxonomyName": "Chiropractor",
        "LicenseNumber": "CH10194",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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