Individual
DR. GREGG ALLEN MEDEIROS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
1196 ELMWOOD AVE, PROVIDENCE, RI 02907-3716
(401) 461-1600
(401) 461-3500
Mailing address
43 MOUNTAIN AVE, RIVERSIDE, RI 02915-5015
(401) 440-4228
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
DCP00545
RI
111NI0013X
Independent Medical Examiner Chiropractor
Primary
DCP00545
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024812
MEDICARE PTAN
RI
Enumeration date
10/23/2006
Last updated
05/23/2012
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