Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | IL |
NPI | 1003990904 |
---|---|
Provider Name | Gregory G Gebhart |
First Address | Chicago, IL 60602-2448 |
Second Address | Chicago, IL 60602-2448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1633792 | BLUE CROSS BLUE SHIELD (01) | IL |
658740 | AMERICAN CHIROPRACTIC NET (01) | IL |