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General NPI Number Information
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NPI Number | 1093858631
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Entity Type | Organization
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Legal Business Name | GREENQUIST CHIROPRACTIC, S.C.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 110 THOMPSON PARKWAY, #4
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City | ST. CROIX FALLS
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State | WI
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Zip | 54024
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Country | US
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Telephone | 715-483-1256
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Fax |
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Provider Business Mailing Address
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Address Line | 110 THOMPSON PARKWAY, #4
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City | ST. CROIX FALLS
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State | WI
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Zip | 54024
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRES.
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Name | TORY GREENQUIST
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Credential |
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Telephone | 715-483-1256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3682-012
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License Number State | WI
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