Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 038-010326 | IL |
NPI | 1003927914 |
---|---|
Provider Name | Dr. Matthew Ryan Greenberg |
First Address | Round Lake, IL 60073-5622 |
Second Address | Oak Brook, IL 60523-2242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 12/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V08014 | (02) | IL |