Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | DC11064 | CA |
NPI | 1316049786 |
---|---|
Provider Name | Dr. David Allen Gregg |
First Address | San Diego, CA 92115-1819 |
Second Address | San Diego, CA 92115-1819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11064 | (02) | CA |
DC0110640 | BLUE CROSS & BLUE SHIELD (01) | CA |