Provider Demographics
NPI:1710620778
Name:GREENWOOD CHIROPRACTIC HEALTH AND SPORTS PERFORMANCE LLC
Entity Type:Organization
Organization Name:GREENWOOD CHIROPRACTIC HEALTH AND SPORTS PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-308-4600
Mailing Address - Street 1:304 WILSON AVE W
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-2476
Mailing Address - Country:US
Mailing Address - Phone:715-308-4600
Mailing Address - Fax:
Practice Address - Street 1:304 WILSON AVE W
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-2476
Practice Address - Country:US
Practice Address - Phone:715-308-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty