Provider Demographics
NPI:1689945156
Name:GREIG, BO WESLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:BO
Middle Name:WESLEY
Last Name:GREIG
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 1:13767 VALE ST NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-4075
Mailing Address - Country:US
Mailing Address - Phone:763-227-4173
Mailing Address - Fax:
Practice Address - Street 1:804 FREEPORT AVE NW
Practice Address - Street 2:SUITE C
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-2632
Practice Address - Country:US
Practice Address - Phone:763-441-0644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-15
Last Update Date:2012-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5598111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor