Provider Demographics
NPI:1104805993
Name:MCGINN, GREGORY (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:MCGINN
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 1:1116 E 3300 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2530
Mailing Address - Country:US
Mailing Address - Phone:801-485-2100
Mailing Address - Fax:801-485-2101
Practice Address - Street 1:1116 E 3300 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2530
Practice Address - Country:US
Practice Address - Phone:801-485-2100
Practice Address - Fax:801-485-2101
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT161795-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000005646Medicare ID - Type Unspecified