Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 12859 | TX |
N | 111NS0005X | Chiropractic Sports Physician | 12859 | TX |
NPI | 1346633591 |
---|---|
Provider Name | Dr. Amber Dawn Depasquale Gregory |
First Address | Spring, TX 77388-3687 |
Second Address | Spring, TX 77388 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2015 |
Last Update Date | 23/08/2018 |