Provider Demographics
NPI:1013184175
Name:GREENLEE CHIROPRACTIC AND ACUPUNCTURE CLINIC INC
Entity Type:Organization
Organization Name:GREENLEE CHIROPRACTIC AND ACUPUNCTURE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP INCORPORATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:SHAY
Authorized Official - Last Name:GREENLEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-490-9800
Mailing Address - Street 1:10622 STATE ROUTE 662 W
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-8845
Mailing Address - Country:US
Mailing Address - Phone:812-490-9800
Mailing Address - Fax:812-490-9801
Practice Address - Street 1:10622 STATE ROUTE 662 W
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8845
Practice Address - Country:US
Practice Address - Phone:812-490-9800
Practice Address - Fax:812-490-9801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002036A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200406940Medicaid
INU92864Medicare PIN