Provider Demographics
NPI:1154407948
Name:SPIESS, GREGORY JOSEPH (DC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:JOSEPH
Last Name:SPIESS
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 1:411 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-1700
Mailing Address - Country:US
Mailing Address - Phone:716-777-1630
Mailing Address - Fax:
Practice Address - Street 1:411 MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-1700
Practice Address - Country:US
Practice Address - Phone:167-777-1630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27866111N00000X
NY013544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27866OtherSTATE BOARD OF CHIRO