Provider Demographics
NPI:1942258611
Name:GREENSPAN, KEVIN ROLAND (DC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ROLAND
Last Name:GREENSPAN
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 1:3174 US HIGHWAY 70 W
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-6302
Mailing Address - Country:US
Mailing Address - Phone:828-669-5314
Mailing Address - Fax:828-669-2210
Practice Address - Street 1:3174 US HIGHWAY 70 W
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-6302
Practice Address - Country:US
Practice Address - Phone:828-669-5314
Practice Address - Fax:828-669-2210
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1950111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890844KMedicaid
NCU38201Medicare UPIN
NC890844KMedicaid