Provider Demographics
NPI:1053387118
Name:SHEPPARD, GREGORY B (DC,)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:B
Last Name:SHEPPARD
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 1:6800 W GATE BLVD
Mailing Address - Street 2:SUITE 117
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-4883
Mailing Address - Country:US
Mailing Address - Phone:512-445-3366
Mailing Address - Fax:512-444-8283
Practice Address - Street 1:6800 W GATE BLVD
Practice Address - Street 2:SUITE 117
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-4883
Practice Address - Country:US
Practice Address - Phone:512-445-3366
Practice Address - Fax:512-444-8283
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5363111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8D8343Medicare ID - Type Unspecified
TXT05290Medicare UPIN