Provider Demographics
NPI:1487793626
Name:GREENWAY, GEOFFREY DAVID (DC)
Entity type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:DAVID
Last Name:GREENWAY
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 1:123 S THIRD AVE
Mailing Address - Street 2:STE 6
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1358
Mailing Address - Country:US
Mailing Address - Phone:208-255-1108
Mailing Address - Fax:208-265-5696
Practice Address - Street 1:229 PINE ST
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1336
Practice Address - Country:US
Practice Address - Phone:208-255-1108
Practice Address - Fax:208-265-5696
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA1062111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1377457OtherPTAN
IDC4066OtherBILING # BLUE CROSS
IDC4066OtherBILING # BLUE CROSS
IDV01530Medicare UPIN