Provider Demographics
NPI:1649439191
Name:PATRICK GRECO DC INC
Entity type:Organization
Organization Name:PATRICK GRECO DC INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:404-885-1414
Mailing Address - Street 1:650 PONCE DE LEON AVE NE
Mailing Address - Street 2:SUITE 600A
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1804
Mailing Address - Country:US
Mailing Address - Phone:404-885-1414
Mailing Address - Fax:404-885-1476
Practice Address - Street 1:650 PONCE DE LEON AVE NE
Practice Address - Street 2:SUITE 600A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1804
Practice Address - Country:US
Practice Address - Phone:404-885-1414
Practice Address - Fax:404-885-1476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6604Medicare PIN