Provider Demographics
NPI:1295763621
Name:GREENER, DANIEL BRUCE (DC)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BRUCE
Last Name:GREENER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14930 LAPLAISANCE RD
Mailing Address - Street 2:STE 116
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3871
Mailing Address - Country:US
Mailing Address - Phone:734-242-4422
Mailing Address - Fax:
Practice Address - Street 1:14930 LAPLAISANCE RD
Practice Address - Street 2:SUITE 134
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3880
Practice Address - Country:US
Practice Address - Phone:724-242-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3U77862Medicare UPIN
MI0P30950Medicare ID - Type Unspecified