Provider Demographics
NPI:1033691241
Name:GREENLEE, JEFFREY RAY JR (DC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:RAY
Last Name:GREENLEE
Suffix:JR
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 1:4444 CHEROKEE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-3680
Mailing Address - Country:US
Mailing Address - Phone:858-699-1291
Mailing Address - Fax:
Practice Address - Street 1:2245 FENTON PKWY STE 109
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4737
Practice Address - Country:US
Practice Address - Phone:619-624-2424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor