Provider Demographics
NPI:1356342026
Name:GREENWOOD, STUART ALDEN (DC)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:ALDEN
Last Name:GREENWOOD
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 1:81557 DR CARREON BLVD
Mailing Address - Street 2:SUITE B-5
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5517
Mailing Address - Country:US
Mailing Address - Phone:760-347-4554
Mailing Address - Fax:760-347-1623
Practice Address - Street 1:81557 DR CARREON BLVD
Practice Address - Street 2:SUITE B-5
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5517
Practice Address - Country:US
Practice Address - Phone:760-347-4554
Practice Address - Fax:760-347-1623
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13784111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
13784 01OtherEXCLUSIVE CARE PROVIDER #
CADC0137840Medicaid
13784 01OtherEXCLUSIVE CARE PROVIDER #
CADC0137840Medicaid