MEDICARE: DR. ANDREW J GREGG D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	8288	AZ

General Provider Information

NPI Number	:	1295085348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW J GREGG D.C.

Provider Business Mailing Address
First Line	:	1501 S YALE ST STE 250
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-7336
Country	:	US
Telephone Number	:	928-556-0707
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 S YALE ST STE 250
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-7336
Country	:	US
Telephone Number	:	928-556-0707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2012
Last Update Date	:	09/17/2012

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