Individual provider Active NPI

Gregory Lewis Haddock, D.C.

  • Chiropractor
  • Salt Lake City, UT
National Provider Identifier
1679775563
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
5770376-1202 Issued in UT
Practice address
715 E 3900 S
Suite 109
Salt Lake City, UT 84107-2182
Phone
(801) 268-4993
NPI assigned
Jun 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 5770376-1202 UT Primary

Addresses

Primary practice location

715 E 3900 S
Suite 109
Salt Lake City, UT 84107-2182

Mailing address

715 E 3900 S
Suite 109
Salt Lake City, UT 84107-2182
Phone (801) 268-4993

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060308000032 UT Practitioner - Chiropractic 7719970946 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Cleveland Chiropractic College - Los Angeles, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5280 S Commerce Dr
Suite E140
Murray, UT 84107-5570
Phone (801) 268-4993

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mt. Olympus Clinic of Chiropractic Corporation CurrentSince Jan 9, 2006 Accepting new patients

Locations

5280 S Commerce Dr
Ste E140
Salt Lake City, UT 84107
Phone (801) 268-4993

715 E 3900 S
Ste 109
Salt Lake City, UT 84107
Phone (801) 268-4993

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1679775563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 E 3900 S",
            "address_2": "SUITE 109",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841072182",
            "telephone_number": "801-268-4993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 E 3900 S",
            "address_2": "SUITE 109",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841072182",
            "telephone_number": "801-268-4993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADDOCK",
        "first_name": "GREGORY",
        "middle_name": "LEWIS",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-03",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "UT",
            "license": "5770376-1202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.