MEDICARE: PATRICK GRECO DC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	6822	GA

General Provider Information

NPI Number	:	1649439191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRICK GRECO DC INC

Provider Business Mailing Address
First Line	:	650 PONCE DE LEON AVE NE
Second Line	:	SUITE 600A
City	:	ATLANTA
State	:	GA
Zip	:	30308-1804
Country	:	US
Telephone Number	:	404-885-1414
Fax Number	:	404-885-1476

Provider Business Practice Location Address
First Line	:	650 PONCE DE LEON AVE NE
Second Line	:	SUITE 600A
City	:	ATLANTA
State	:	GA
Zip	:	30308-1804
Country	:	US
Telephone Number	:	404-885-1414
Fax Number	:	404-885-1476

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PATRICK GRECO
Credential	:	D.C.
Telephone Number	:	404-885-1414

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	04/13/2011

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