Provider Demographics
NPI:1417087206
Name:LAURI GREITZER
Entity Type:Organization
Organization Name:LAURI GREITZER
Other - Org Name:PARADISE FAMILY & SPORTS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURI
Authorized Official - Middle Name:LAWTON
Authorized Official - Last Name:GREITZER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-877-9333
Mailing Address - Street 1:6848 SKYWAY STE T
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3936
Mailing Address - Country:US
Mailing Address - Phone:530-877-9333
Mailing Address - Fax:530-877-2996
Practice Address - Street 1:6848 SKYWAY STE T
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3936
Practice Address - Country:US
Practice Address - Phone:530-877-9333
Practice Address - Fax:530-877-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20283305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU40369Medicare UPIN
CADC0202830Medicare ID - Type UnspecifiedMEDICARE