Provider Demographics
NPI:1356519243
Name:GREGORY F. KOORS
Entity type:Organization
Organization Name:GREGORY F. KOORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:F
Authorized Official - Last Name:KOORS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-683-5678
Mailing Address - Street 1:2201 WILLAMETTE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3091
Mailing Address - Country:US
Mailing Address - Phone:541-683-5678
Mailing Address - Fax:541-343-7350
Practice Address - Street 1:2201 WILLAMETTE ST
Practice Address - Street 2:SUITE C
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3091
Practice Address - Country:US
Practice Address - Phone:541-683-5678
Practice Address - Fax:541-373-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR272657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
117689Medicare PIN
V02960Medicare UPIN