Healthcare Provider Details

I. General information

NPI: 1023367349
Provider Name (Legal Business Name): GREENWALD DC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 NW 4TH ST
BOCA RATON FL
33432-3826
US

IV. Provider business mailing address

160 NW 4TH ST
BOCA RATON FL
33432-3826
US

V. Phone/Fax

Practice location:
  • Phone: 561-391-6822
  • Fax: 561-391-6823
Mailing address:
  • Phone: 561-391-6822
  • Fax: 561-391-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberCH0003361
License Number StateFL

VIII. Authorized Official

Name: DR. STUART NEIL GREENWALD
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 561-391-6822