Healthcare Provider Details

I. General information

NPI: 1376529800
Provider Name (Legal Business Name): CORNELIUS JOSEPH MCGEEHAN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 DARLINGTON RD
HOLIDAY FL
34690-3906
US

IV. Provider business mailing address

4630 DARLINGTON RD
HOLIDAY FL
34690-3906
US

V. Phone/Fax

Practice location:
  • Phone: 727-937-4223
  • Fax: 727-937-4224
Mailing address:
  • Phone: 727-937-4223
  • Fax: 727-937-4224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH001619
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: