Provider Demographics
NPI:1356325765
Name:GREENLEE, ADAM S (DC, LAC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:S
Last Name:GREENLEE
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2788 REINFORD DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9146
Mailing Address - Country:US
Mailing Address - Phone:812-449-7424
Mailing Address - Fax:
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
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002036A111N00000X
IN81000041A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200406940AMedicaid
IN256840AOtherMEDICARE PTAN
INU92864Medicare UPIN