Provider Demographics
NPI:1285702001
Name:PRIEST, GREGORY CHARLES (DC, DABCO)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:CHARLES
Last Name:PRIEST
Suffix:
Gender:M
Credentials:DC, DABCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 WALNUT HILL LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75229-5609
Mailing Address - Country:US
Mailing Address - Phone:972-438-6932
Mailing Address - Fax:
Practice Address - Street 1:2540 WALNUT HILL LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-5609
Practice Address - Country:US
Practice Address - Phone:972-438-6932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4353111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT55666Medicare UPIN
FL88057ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER