Healthcare Provider Details

I. General information

NPI: 1982648952
Provider Name (Legal Business Name): MICHAEL TERRENCE MCGHEE DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 WASHINGTON ST SUITE B-1
SANTA CLARA CA
95050-5975
US

IV. Provider business mailing address

225 WASHINGTON ST SUITE B-1
SANTA CLARA CA
95050-5975
US

V. Phone/Fax

Practice location:
  • Phone: 408-274-7990
  • Fax: 408-247-7990
Mailing address:
  • Phone: 408-274-7990
  • Fax: 408-247-7990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number22767
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: