Provider Demographics
NPI:1942323134
Name:GREENLAW, SANDRA LEE (DC)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEE
Last Name:GREENLAW
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 W BOYLSTON ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-2365
Mailing Address - Country:US
Mailing Address - Phone:508-856-7213
Mailing Address - Fax:508-856-0193
Practice Address - Street 1:360 W BOYLSTON ST
Practice Address - Street 2:SUITE 206
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-2365
Practice Address - Country:US
Practice Address - Phone:508-856-7213
Practice Address - Fax:508-856-0193
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1588111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY45002Medicare ID - Type Unspecified