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General NPI Number Information
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NPI Number | 1902959778
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Entity Type | Organization
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Legal Business Name | GREATHOUSE CHIROPRACTIC INC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 130 AVENIDA CABRILLO STE C
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-5509
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Country | US
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Telephone | 949-481-8282
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Fax | 949-218-6303
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Provider Business Mailing Address
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Address Line | 130 AVENIDA CABRILLO STE C
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-5509
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Country | US
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Telephone | 949-481-8282
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Fax | 949-218-6303
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. WAYNE GREATHOUSE
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Credential | DC
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Telephone | 949-481-8282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 28049
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License Number State | CA
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