MEDICARE: DR. DOUGLAS SCOTT GRECO D.C.

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	X010568-1	NY
2	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1073605556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS SCOTT GRECO D.C.

Provider Business Mailing Address
First Line	:	115 HAMPTON WAY
Second Line	:
City	:	MERRICK
State	:	NY
Zip	:	11566-5026
Country	:	US
Telephone Number	:	516-960-8594
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 BROADWAY
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11040-5333
Country	:	US
Telephone Number	:	516-248-2870
Fax Number	:

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	04/22/2013

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