Provider Demographics
NPI:1427263433
Name:LEBRE, GREGORY JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JAMES
Last Name:LEBRE
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 1:3641 CLIFTY DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-1649
Mailing Address - Country:US
Mailing Address - Phone:812-273-4377
Mailing Address - Fax:812-273-4377
Practice Address - Street 1:3641 CLIFTY DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-1649
Practice Address - Country:US
Practice Address - Phone:812-273-4377
Practice Address - Fax:812-273-4377
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN194970Medicare PIN