Provider Demographics
NPI:1770967564
Name:GREENPATH CLINIC
Entity type:Organization
Organization Name:GREENPATH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSHIOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-460-6733
Mailing Address - Street 1:1749 S NAPERVILLE RD STE 207
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-5892
Mailing Address - Country:US
Mailing Address - Phone:630-460-6733
Mailing Address - Fax:
Practice Address - Street 1:1749 S NAPERVILLE RD STE 207
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5892
Practice Address - Country:US
Practice Address - Phone:630-460-6733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty