Provider Demographics
NPI:1487828224
Name:GREGORY J. HOUGH, D.C., P.C.
Entity type:Organization
Organization Name:GREGORY J. HOUGH, D.C., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-492-8300
Mailing Address - Street 1:PO BOX 15959
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46885-5959
Mailing Address - Country:US
Mailing Address - Phone:260-492-8300
Mailing Address - Fax:260-492-8301
Practice Address - Street 1:4771 TRIER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-4968
Practice Address - Country:US
Practice Address - Phone:260-492-8300
Practice Address - Fax:260-492-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100081330AMedicaid
IN100081330AMedicaid
IN136080AMedicare PIN