1194811299 NPI number — GREENBERG CHIROPRACTIC CARE LLC

Table of content: (NPI 1194811299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194811299 NPI number — GREENBERG CHIROPRACTIC CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENBERG CHIROPRACTIC CARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194811299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5407 EXCELSIOR BLVD
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
ST LOUIS PK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-920-9247
Provider Business Mailing Address Fax Number:
952-922-3480

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5407 EXCELSIOR BLVD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
ST LOUIS PK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-920-9247
Provider Business Practice Location Address Fax Number:
952-922-3480
Provider Enumeration Date:
10/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GREENBERG
Authorized Official First Name:
TINA
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
952-920-9247

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  MN1715 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 111N00000X , with the licence number: WA1442 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 111N00000X , with the licence number: OK2045 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 171100000X , with the licence number: 632 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 413G1GR . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".