Provider Demographics
NPI:1093861759
Name:GREEN CHIROPRACTIC
Entity Type:Organization
Organization Name:GREEN CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHURCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-896-3366
Mailing Address - Street 1:4030 MASSILLON RD
Mailing Address - Street 2:STE C
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7867
Mailing Address - Country:US
Mailing Address - Phone:330-896-3366
Mailing Address - Fax:
Practice Address - Street 1:4030 MASSILLON RD
Practice Address - Street 2:STE C
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7867
Practice Address - Country:US
Practice Address - Phone:330-896-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3408261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU97984Medicare UPIN
OH9340541Medicare PIN