Provider Demographics
NPI:1528521341
Name:GREENWOOD SPINE CARE PLLC
Entity type:Organization
Organization Name:GREENWOOD SPINE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HAUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-200-1050
Mailing Address - Street 1:11001 S KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2221
Mailing Address - Country:US
Mailing Address - Phone:773-585-5550
Mailing Address - Fax:773-585-1061
Practice Address - Street 1:11001 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-2221
Practice Address - Country:US
Practice Address - Phone:773-585-5550
Practice Address - Fax:773-585-1061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty