Healthcare Provider Details

I. General information

NPI: 1003055385
Provider Name (Legal Business Name): B GREENWALD MEDICAL, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2009
Last Update Date: 04/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 SE BRIDGE RD
HOBE SOUND FL
33455-5312
US

IV. Provider business mailing address

8929 SE BRIDGE RD
HOBE SOUND FL
33455-5312
US

V. Phone/Fax

Practice location:
  • Phone: 772-546-9591
  • Fax: 772-546-9535
Mailing address:
  • Phone: 772-546-9591
  • Fax: 772-546-9535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9562
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7238
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOS10065
License Number StateFL

VIII. Authorized Official

Name: DR. BRETT MARC GREENWALD
Title or Position: OWNER
Credential: D.C.
Phone: 772-546-9591