MEDICARE: DR. DARRYL R GREGORY DC

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	4626	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000209773	OTHER	KY	BCBS

General Provider Information

NPI Number	:	1851471346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARRYL R GREGORY DC

Provider Business Mailing Address
First Line	:	3198 CUSTER DR STE 100
Second Line	:	SOUTHSIDE CHIROPRACTIC PSC
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4000
Country	:	US
Telephone Number	:	859-373-0800
Fax Number	:	859-255-4104

Provider Business Practice Location Address
First Line	:	3198 CUSTER DR STE 100
Second Line	:	SOUTHSIDE CHIROPRACTIC PSC
City	:	LEXINGTON
State	:	KY
Zip	:	40517-4000
Country	:	US
Telephone Number	:	859-373-0800
Fax Number	:	859-255-4104

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	05/31/2016

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Directions to “ DR. DARRYL R GREGORY DC” Practice Location

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