Provider Demographics
NPI:1801154356
Name:GREGORY, KENDALL DAVID (DC)
Entity type:Individual
Prefix:
First Name:KENDALL
Middle Name:DAVID
Last Name:GREGORY
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 1:462 S. PRESIDENT STREET
Mailing Address - Street 2:UNIT 303
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188
Mailing Address - Country:US
Mailing Address - Phone:630-415-7021
Mailing Address - Fax:
Practice Address - Street 1:462 S PRESIDENT ST
Practice Address - Street 2:UNIT 303
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188-3221
Practice Address - Country:US
Practice Address - Phone:630-415-7021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038.011824111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0900XChiropractic ProvidersChiropractorInternist