Provider Demographics
NPI:1013049345
Name:GREENREICH, STEPHANIE LOUISE (DC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LOUISE
Last Name:GREENREICH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LOUISE
Other - Last Name:GREENREICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:24837 104TH AVE SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-6800
Mailing Address - Country:US
Mailing Address - Phone:253-854-7700
Mailing Address - Fax:253-854-2986
Practice Address - Street 1:24837 104TH AVE SE
Practice Address - Street 2:SUITE 100
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-6800
Practice Address - Country:US
Practice Address - Phone:253-854-7700
Practice Address - Fax:253-854-2986
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00033796111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB37373OtherMEDICARE PTAN