Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC20611 | CA |
NPI | 1003821471 |
---|---|
Provider Name | Dr. Gerald Grega |
First Address | Reseda, CA 91335-3380 |
Second Address | Inglewood, CA 90301-1769 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/07/2007 |