Provider Demographics
NPI:1992073027
Name:GREENAWALT CHIROPRACTIC
Entity type:Organization
Organization Name:GREENAWALT CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GREENAWALT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-363-8989
Mailing Address - Street 1:7500 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2742
Mailing Address - Country:US
Mailing Address - Phone:702-363-8989
Mailing Address - Fax:702-363-3573
Practice Address - Street 1:7500 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2742
Practice Address - Country:US
Practice Address - Phone:702-363-8989
Practice Address - Fax:702-363-3573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-04
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV3602062Medicaid
NVU13989Medicare UPIN