=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942570304
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DOUG S. GREENSPAN, D.C, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2012
-----------------------------------------------------
Last Update Date | 01/03/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105-20 CROSS BAY BOULEVARD
-----------------------------------------------------
City | OZONE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11417-1515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-641-8800
-----------------------------------------------------
Fax | 718-641-1344
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 105-20 CROSS BAY BOULEVARD
-----------------------------------------------------
City | OZONE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11417-1515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-641-8800
-----------------------------------------------------
Fax | 718-641-1344
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DOUG STUART GREENSPAN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 718-641-8800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X005911
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------