Provider Demographics
NPI:1578629473
Name:GREENLEE CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:GREENLEE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GREENLEE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:573-438-1999
Mailing Address - Street 1:GREENLEE CHIROPRACTIC
Mailing Address - Street 2:417 EAST HIGH ST
Mailing Address - City:POTOSI
Mailing Address - State:MO
Mailing Address - Zip Code:63664
Mailing Address - Country:US
Mailing Address - Phone:573-438-1999
Mailing Address - Fax:573-438-1777
Practice Address - Street 1:GREENLEE CHIROPRACTIC
Practice Address - Street 2:417 EAST HIGH ST
Practice Address - City:POTOSI
Practice Address - State:MO
Practice Address - Zip Code:63664
Practice Address - Country:US
Practice Address - Phone:573-438-1999
Practice Address - Fax:573-438-1777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003017111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO659502OtherUNITED HEALTH
MO566271OtherHEALTHLINK
MO566271OtherHEALTHLINK
U96687Medicare UPIN