Provider Demographics
NPI:1881796803
Name:GREENBERG, MITCHELL R (DC)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:R
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 1:1747 EVANS RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3869
Mailing Address - Country:US
Mailing Address - Phone:321-951-9222
Mailing Address - Fax:321-952-1187
Practice Address - Street 1:1747 EVANS RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3869
Practice Address - Country:US
Practice Address - Phone:321-951-9222
Practice Address - Fax:321-952-1187
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH4448111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
T54968Medicare UPIN
70372ZMedicare ID - Type Unspecified