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Organization

GREENHEAD DIAGNOSTICS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MACKIE DAWAYNE GOURLEY JR. DC (OWNER)
(214) 680-9146
Entity
Organization

Contact information

Practice address
637 MERLOT CT, FAIRVIEW, TX 75069-1521
(214) 383-9622
Mailing address
3245 MAIN ST, SUITE 235-157, FRISCO, TX 75034-4411
(214) 383-9622

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
12359
TX

Other

Enumeration date
10/08/2015
Last updated
10/08/2015
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