Provider Demographics
NPI:1194811299
Name:GREENBERG CHIROPRACTIC CARE LLC
Entity type:Organization
Organization Name:GREENBERG CHIROPRACTIC CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:952-920-9247
Mailing Address - Street 1:5407 EXCELSIOR BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ST LOUIS PK
Mailing Address - State:MN
Mailing Address - Zip Code:55416
Mailing Address - Country:US
Mailing Address - Phone:952-920-9247
Mailing Address - Fax:952-922-3480
Practice Address - Street 1:5407 EXCELSIOR BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:ST LOUIS PK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:952-920-9247
Practice Address - Fax:952-922-3480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN1715111N00000X
WAWA1442111N00000X
OKOK2045111N00000X
MN632171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN413G1GROtherBLUE CROSS BLUE SHIELD
C04248Medicare ID - Type Unspecified