Provider Demographics
NPI:1023377892
Name:GREENE COUNTY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:GREENE COUNTY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERREN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CULLISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-875-2225
Mailing Address - Street 1:6 N COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47471-1415
Mailing Address - Country:US
Mailing Address - Phone:812-875-2225
Mailing Address - Fax:812-875-1068
Practice Address - Street 1:6 N COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47471-1415
Practice Address - Country:US
Practice Address - Phone:812-875-2225
Practice Address - Fax:812-875-1068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002555A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center