Provider Demographics
NPI:1851486062
Name:GRECO, JULIAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:
Last Name:GRECO
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 1:123 DINA AVE
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201
Mailing Address - Country:US
Mailing Address - Phone:570-453-2866
Mailing Address - Fax:570-453-4299
Practice Address - Street 1:168 SUSQUEHANNA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18202
Practice Address - Country:US
Practice Address - Phone:570-453-2866
Practice Address - Fax:570-453-4299
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007602L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU77903Medicare UPIN
PA033776Medicare ID - Type Unspecified