MEDICARE: JEFFREY RAY GREENLEE JR. DC

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	33938	CA

General Provider Information

NPI Number	:	1033691241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY RAY GREENLEE JR. DC

Provider Business Mailing Address
First Line	:	4444 CHEROKEE AVE APT 3
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-3680
Country	:	US
Telephone Number	:	858-699-1291
Fax Number	:

Provider Business Practice Location Address
First Line	:	2245 FENTON PKWY STE 109
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-4737
Country	:	US
Telephone Number	:	619-624-2424
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2018
Last Update Date	:	09/04/2018

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