Provider Demographics
NPI:1871624478
Name:GREGG, BRIAN GLEN (DC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:GLEN
Last Name:GREGG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 S CHEROKEE LN
Mailing Address - Street 2:SUITE 1130
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4793
Mailing Address - Country:US
Mailing Address - Phone:678-494-0320
Mailing Address - Fax:678-494-0340
Practice Address - Street 1:3237 S CHEROKEE LN
Practice Address - Street 2:SUITE 1130
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4793
Practice Address - Country:US
Practice Address - Phone:678-494-0320
Practice Address - Fax:678-494-0340
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006078111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU94489Medicare UPIN
GA104088Medicare ID - Type Unspecified