Individual
MR. GREGORY JAMES DEJONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT
Contact information
Practice address
W1910 SLEEPY HOLLOW CT, KAUKAUNA, WI 54130-9429
(920) 788-4760
Mailing address
W1910 SLEEPY HOLLOW CT, KAUKAUNA, WI 54130-9429
(920) 788-4760
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
74-039
WI
Other
Enumeration date
01/06/2007
Last updated
07/08/2007
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