Provider Demographics
NPI:1902861768
Name:SCHEREK, GREGORY JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JAY
Last Name:SCHEREK
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 1:118 S MARINER CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5607
Mailing Address - Country:US
Mailing Address - Phone:480-497-9497
Mailing Address - Fax:
Practice Address - Street 1:1265 W GUADALUPE RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-9101
Practice Address - Country:US
Practice Address - Phone:480-755-1001
Practice Address - Fax:480-755-4703
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ04264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT42113Medicare UPIN
AZ107761Medicare PIN