Provider Demographics
NPI:1720076839
Name:MONROE, GREGORY DARRELL (DC)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:DARRELL
Last Name:MONROE
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 1:511 W VISALIA RD
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:CA
Mailing Address - Zip Code:93221-1019
Mailing Address - Country:US
Mailing Address - Phone:559-592-3124
Mailing Address - Fax:559-592-2457
Practice Address - Street 1:511 W VISALIA RD
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:CA
Practice Address - Zip Code:93221-1019
Practice Address - Country:US
Practice Address - Phone:559-592-3124
Practice Address - Fax:559-592-2457
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor