Provider Demographics
NPI:1871637207
Name:GREENSFELDER, JOHN R (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:GREENSFELDER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1350 BLAIR DR STE HH
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1333
Mailing Address - Country:US
Mailing Address - Phone:410-674-8605
Mailing Address - Fax:410-674-8608
Practice Address - Street 1:1350 BLAIR DR STE HH
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1333
Practice Address - Country:US
Practice Address - Phone:410-674-8605
Practice Address - Fax:410-674-8608
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01820111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD150PMedicare PIN
MDU70273Medicare UPIN