Provider Demographics
NPI:1104174432
Name:CORNELIUS J. MCGEEHAN D.C., INC.
Entity type:Organization
Organization Name:CORNELIUS J. MCGEEHAN D.C., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORNELIUS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCGEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-937-4223
Mailing Address - Street 1:4630 DARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34690-3906
Mailing Address - Country:US
Mailing Address - Phone:727-937-4223
Mailing Address - Fax:727-937-4224
Practice Address - Street 1:23 E TARPON AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3449
Practice Address - Country:US
Practice Address - Phone:727-937-4223
Practice Address - Fax:727-937-4224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH1619305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3800032 00Medicaid