Provider Demographics
NPI:1285778043
Name:GREENLEE, DANIEL FREDERICK (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:FREDERICK
Last Name:GREENLEE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 BLACK LAKE BLVD SW STE C
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-5718
Mailing Address - Country:US
Mailing Address - Phone:360-705-0900
Mailing Address - Fax:360-754-6151
Practice Address - Street 1:1824 BLACK LAKE BLVD SW STE C
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-5718
Practice Address - Country:US
Practice Address - Phone:360-705-0900
Practice Address - Fax:360-754-6151
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8802144Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
WA8802146Medicare UPIN
WA8802146Medicare PIN