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General NPI Number Information
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NPI Number | 1528521341
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Entity Type | Organization
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Legal Business Name | GREENWOOD SPINE CARE PLLC
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Dates
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Enumeration Date | 04/09/2019
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 11001 S KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60655-2221
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Country | US
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Telephone | 773-585-5550
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Fax | 773-585-1061
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Provider Business Mailing Address
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Address Line | 11001 S KEDZIE AVE
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City | CHICAGO
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State | IL
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Zip | 60655-2221
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Country | US
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Telephone | 773-585-5550
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Fax | 773-585-1061
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Authorized Official
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Title or Position | COO
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Name | DR. MICHAEL WILLIAM HAUSCH
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Credential | DC
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Telephone | 630-200-1050
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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 |
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License Number State |
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