Provider Demographics
NPI:1518060904
Name:GREENBERG, JAY MELVIN (DC)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:MELVIN
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29218 HIGHWAY 58 BLVD
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-7407
Mailing Address - Country:US
Mailing Address - Phone:651-388-8294
Mailing Address - Fax:651-388-7461
Practice Address - Street 1:29218 HIGHWAY 58 BLVD
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-7407
Practice Address - Country:US
Practice Address - Phone:651-388-8294
Practice Address - Fax:651-388-7461
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
31174GROtherBLUE CROSS BLUE SHIELD
230288OtherCHIROCARE
230288OtherCHIROCARE