Provider Demographics
NPI:1427075076
Name:GREENSIDES, DEREK F I (DC)
Entity type:Individual
Prefix:DR
First Name:DEREK
Middle Name:F I
Last Name:GREENSIDES
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 1:841 SAN BRUNO AVE W
Mailing Address - Street 2:#5
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3443
Mailing Address - Country:US
Mailing Address - Phone:650-872-3585
Mailing Address - Fax:650-872-3212
Practice Address - Street 1:841 SAN BRUNO AVE W
Practice Address - Street 2:#5
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3443
Practice Address - Country:US
Practice Address - Phone:650-872-3585
Practice Address - Fax:650-872-3212
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10309111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00103090DCMedicare ID - Type Unspecified