Organization
JAMES E GREATHOUSE, JR. DCPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARILYN A GREATHOUSE (OFFICE MANAGER)
(321) 725-6314
Entity
Organization
Contact information
Practice address
1589 S WICKHAM RD, W MELBOURNE, FL 32904-3540
(321) 725-6314
(321) 724-1533
Mailing address
1589 S WICKHAM RD, W MELBOURNE, FL 32904-3540
(321) 725-6314
(321) 724-1533
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
CH4246
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
88014
MEDICARE PTAN
FL
Enumeration date
02/20/2012
Last updated
02/20/2012
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