Provider Demographics
NPI:1336849959
Name:GREAVES, CONNOR JOSEPH
Entity Type:Individual
Prefix:MR
First Name:CONNOR
Middle Name:JOSEPH
Last Name:GREAVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 S FLORENCE ST APT 6
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-4498
Mailing Address - Country:US
Mailing Address - Phone:573-356-1855
Mailing Address - Fax:
Practice Address - Street 1:1417 S FLORENCE ST APT 6
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-4498
Practice Address - Country:US
Practice Address - Phone:573-356-1855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer