MEDICARE: DR. KENNETH MICHAEL GREENBERG D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	19471	CA

General Provider Information

NPI Number	:	1386632602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH MICHAEL GREENBERG D.C.

Provider Business Mailing Address
First Line	:	8312 LAKE MURRAY BLVD
Second Line	:	SUITE O
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-3435
Country	:	US
Telephone Number	:	619-464-8181
Fax Number	:	619-464-8332

Provider Business Practice Location Address
First Line	:	8312 LAKE MURRAY BLVD
Second Line	:	SUITE O
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-3435
Country	:	US
Telephone Number	:	619-464-8181
Fax Number	:	619-464-8332

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	07/08/2007

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