Provider Demographics
NPI:1134326499
Name:GREENLEE WELLNESS CENTER PS
Entity Type:Organization
Organization Name:GREENLEE WELLNESS CENTER PS
Other - Org Name:PINNACLE SPINE & DISC REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:GREENLEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-705-0900
Mailing Address - Street 1:1824 BLACK LAKE BLVD SW STE C
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-5718
Mailing Address - Country:US
Mailing Address - Phone:360-705-0900
Mailing Address - Fax:360-754-6151
Practice Address - Street 1:1824 BLACK LAKE BLVD SW STE C
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-5718
Practice Address - Country:US
Practice Address - Phone:360-705-0900
Practice Address - Fax:360-754-6151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00034163111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8802144Medicare UPIN