Provider Demographics
NPI:1255421764
Name:GREENALL, STEPHANIE ANNE MARIE (DC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ANNE MARIE
Last Name:GREENALL
Suffix:
Gender:F
Credentials:DC
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:ANNE MARIE
Other - Last Name:GILLESPIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:6501 196TH ST SW
Mailing Address - Street 2:SUITEC
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5980
Mailing Address - Country:US
Mailing Address - Phone:425-775-2288
Mailing Address - Fax:425-778-5476
Practice Address - Street 1:6501 196TH ST SW
Practice Address - Street 2:SUITEC
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5980
Practice Address - Country:US
Practice Address - Phone:425-775-2288
Practice Address - Fax:425-778-5476
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002657111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB22318Medicare ID - Type Unspecified
WAU47648Medicare UPIN