Provider Demographics
NPI:1629776067
Name:GREGORY, NAOMI RUTH (DC)
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:RUTH
Last Name:GREGORY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MISS
Other - First Name:NAOMI
Other - Middle Name:RUTH
Other - Last Name:BADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:863 OLEANDER ST
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-1427
Mailing Address - Country:US
Mailing Address - Phone:928-588-3286
Mailing Address - Fax:
Practice Address - Street 1:130 E YAVAPAI ST STE 5
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-3429
Practice Address - Country:US
Practice Address - Phone:928-588-3286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-15
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9258111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor