Provider Demographics
NPI:1396844916
Name:GREENBERG, TINA SUE (DC)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:SUE
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5407 EXCELSIOR BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416
Mailing Address - Country:US
Mailing Address - Phone:952-920-9247
Mailing Address - Fax:952-922-3480
Practice Address - Street 1:5407 EXCELSIOR BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:952-920-9247
Practice Address - Fax:952-922-3480
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1715111N00000X
OK2045111N00000X
WA1442111N00000X
MN632171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4486621OtherMEDICA
MN413616ROtherB/C B/S
MN35003622Medicare ID - Type Unspecified
MN413616ROtherB/C B/S