Healthcare Provider Details

I. General information

NPI: 1194811299
Provider Name (Legal Business Name): GREENBERG CHIROPRACTIC CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5407 EXCELSIOR BLVD SUITE D
ST LOUIS PK MN
55416
US

IV. Provider business mailing address

5407 EXCELSIOR BLVD SUITE D
ST LOUIS PK MN
55416
US

V. Phone/Fax

Practice location:
  • Phone: 952-920-9247
  • Fax: 952-922-3480
Mailing address:
  • Phone: 952-920-9247
  • Fax: 952-922-3480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberMN1715
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberWA1442
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number632
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberOK2045
License Number StateOK

VIII. Authorized Official

Name: DR. TINA SUE GREENBERG
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: DC
Phone: 952-920-9247