Provider Demographics
NPI:1063528032
Name:CLAYPOOL, GREGORY A (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:CLAYPOOL
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:W194 N16775 EAGLE DR.
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WI
Mailing Address - Zip Code:53037
Mailing Address - Country:US
Mailing Address - Phone:262-677-2700
Mailing Address - Fax:
Practice Address - Street 1:W194 N16775 EAGLE DR.
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WI
Practice Address - Zip Code:53037-9634
Practice Address - Country:US
Practice Address - Phone:262-677-2700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI-3444111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38961600Medicaid
000370615Medicare ID - Type Unspecified
WIU69155Medicare UPIN