Provider Demographics
NPI:1063755908
Name:GREGORY S. HOWARD DC PC
Entity type:Organization
Organization Name:GREGORY S. HOWARD DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:580-335-7373
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:OK
Mailing Address - Zip Code:73542-0216
Mailing Address - Country:US
Mailing Address - Phone:580-335-7373
Mailing Address - Fax:580-335-7799
Practice Address - Street 1:108 S MAIN ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:OK
Practice Address - Zip Code:73542-5431
Practice Address - Country:US
Practice Address - Phone:580-335-7373
Practice Address - Fax:580-335-7799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3272111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU57949Medicare UPIN