Provider Demographics
NPI:1780623231
Name:GREENBERG, MICHAEL WARREN (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WARREN
Last Name:GREENBERG
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 1:1930 MARLTON PIKE E
Mailing Address - Street 2:SUITE D-21
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2150
Mailing Address - Country:US
Mailing Address - Phone:856-489-4480
Mailing Address - Fax:856-489-4481
Practice Address - Street 1:1930 MARLTON PIKE E
Practice Address - Street 2:SUITE D-21
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2150
Practice Address - Country:US
Practice Address - Phone:856-489-4480
Practice Address - Fax:856-489-4481
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00610700111N00000X
PADC007539L111N00000X
PAAJ007539L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3344297OtherAETNA HMO AND POS
NJ200583372OtherHORIZON TRADITIONAL PLANS
NJ2335635OtherUNITED HEALTH CARE
NJ7064114OtherAETNA PPO
NJ2265999000OtherKEYSTONE PLANS
NJ2265999000OtherIBC AND PERSONAL CHOICE
NJ2265999000OtherAMERIHEALTH PLANS
NJ7064114OtherAETNA PPO
NJ071657Medicare ID - Type Unspecified