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General NPI Number Information
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NPI Number | 1952379687
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Entity Type | Individual
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Provider Name | MARK VICTOR GREGG D.C., P.C.
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Gender | Male
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | 2303 N 44TH ST SUITE 15
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City | PHOENIX
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State | AZ
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Zip | 85008-2442
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Country | US
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Telephone | 602-840-3351
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Fax | 602-840-3351
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Provider Business Mailing Address
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Address Line | 2303 N 44TH ST SUITE 15
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City | PHOENIX
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State | AZ
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Zip | 85008-2442
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Country | US
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Telephone | 602-840-3351
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Fax | 602-840-3351
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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 | 4455
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License Number State | AZ
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