Provider Demographics
NPI:1225303613
Name:GRIEB CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:GRIEB CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GRIEB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-935-6050
Mailing Address - Street 1:11885 PERRY HWY
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8343
Mailing Address - Country:US
Mailing Address - Phone:724-935-6050
Mailing Address - Fax:724-935-6071
Practice Address - Street 1:11885 PERRY HWY
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8343
Practice Address - Country:US
Practice Address - Phone:724-935-6050
Practice Address - Fax:724-935-6071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005322L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015546940002Medicaid
PA0015546940002Medicaid