Provider Demographics
NPI:1033463096
Name:GREEN SPRINGS CHIROPRACTIC INC
Entity Type:Organization
Organization Name:GREEN SPRINGS CHIROPRACTIC INC
Other - Org Name:INTHRIVE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:WURTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-705-6567
Mailing Address - Street 1:8657 SANCUS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-4052
Mailing Address - Country:US
Mailing Address - Phone:614-705-6567
Mailing Address - Fax:614-705-6564
Practice Address - Street 1:8657 SANCUS BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240
Practice Address - Country:US
Practice Address - Phone:614-705-6567
Practice Address - Fax:614-705-6564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4133741Medicare PIN