Provider Demographics
NPI:1043513898
Name:GREGG-RYAN CHIROPRACTIC INC
Entity type:Organization
Organization Name:GREGG-RYAN CHIROPRACTIC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:619-466-5858
Mailing Address - Street 1:7151 EL CAJON BLVD
Mailing Address - Street 2:STE J
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115
Mailing Address - Country:US
Mailing Address - Phone:619-466-8585
Mailing Address - Fax:
Practice Address - Street 1:7151 EL CAJON BLVD
Practice Address - Street 2:STE. J
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-1819
Practice Address - Country:US
Practice Address - Phone:619-466-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC11064302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization