Provider Demographics
NPI:1134637382
Name:GNR CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:GNR CHIROPRACTIC LLC
Other - Org Name:WESTSIDE PAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-971-0634
Mailing Address - Street 1:2700 W LAWRENCE AVE STE J3
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-7201
Mailing Address - Country:US
Mailing Address - Phone:217-546-6698
Mailing Address - Fax:217-546-4487
Practice Address - Street 1:2700 W LAWRENCE AVE STE J3
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7201
Practice Address - Country:US
Practice Address - Phone:217-546-6698
Practice Address - Fax:217-546-4487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty