Provider Demographics
NPI:1962795492
Name:GREENWOOD CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:GREENWOOD CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:303-730-1280
Mailing Address - Street 1:5910 S UNIVERSITY BLVD
Mailing Address - Street 2:SUITE A2
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80121-2879
Mailing Address - Country:US
Mailing Address - Phone:303-730-1280
Mailing Address - Fax:303-730-1293
Practice Address - Street 1:5910 S UNIVERSITY BLVD
Practice Address - Street 2:SUITE A2
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80121-2879
Practice Address - Country:US
Practice Address - Phone:303-730-1280
Practice Address - Fax:303-730-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1958261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center