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General NPI Number Information
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NPI Number | 1801337399
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Entity Type | Organization
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Legal Business Name | GREGORY W LOGAN DC LLC
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Dates
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Enumeration Date | 03/16/2017
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Last Update Date | 02/21/2025
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Provider Practice Location Address
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Address Line | 6276 JACKSON RD STE K
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City | ANN ARBOR
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State | MI
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Zip | 48103-9579
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Country | US
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Telephone | 734-660-5869
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Fax |
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Provider Business Mailing Address
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Address Line | 6276 JACKSON RD STE K
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City | ANN ARBOR
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State | MI
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Zip | 48103-9579
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Country | US
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Telephone | 734-660-5869
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGORY WILLIAM LOGAN
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Credential | DC
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Telephone | 734-660-5869
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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 | 2301010543
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License Number State | MI
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