Provider Demographics
NPI:1063435857
Name:GREGORY, LOUIS A (DC, LAC)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:A
Last Name:GREGORY
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 SPRINGFIELD AVE
Mailing Address - Street 2:15 E
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-1138
Mailing Address - Country:US
Mailing Address - Phone:908-374-9399
Mailing Address - Fax:
Practice Address - Street 1:851 SPRINGFIELD AVE
Practice Address - Street 2:15 E
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-1138
Practice Address - Country:US
Practice Address - Phone:908-374-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00621600111N00000X
NYX008300-1111N00000X
CADC24964111N00000X
NJ25MZ00108500171100000X
CAAC 16353171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX008300OtherNEWYORK LICENSE#
NYX008300OtherNEWYORK LICENSE#
NJ081034N9UMedicare ID - Type Unspecified