Provider Demographics
NPI:1568659639
Name:CHARLES H. GREENSWORD, D.C.,PLLC
Entity Type:Organization
Organization Name:CHARLES H. GREENSWORD, D.C.,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:GREENSWORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-838-7973
Mailing Address - Street 1:3324 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2619
Mailing Address - Country:US
Mailing Address - Phone:509-838-7973
Mailing Address - Fax:509-838-1780
Practice Address - Street 1:3324 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2619
Practice Address - Country:US
Practice Address - Phone:509-838-7973
Practice Address - Fax:509-838-1780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH0002644111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA319000292Medicare UPIN