Provider Demographics
NPI:1285184655
Name:GREENWICH SPORTS MEDICINE AT TWIN RINKS LLC
Entity Type:Organization
Organization Name:GREENWICH SPORTS MEDICINE AT TWIN RINKS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIL
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIMES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-531-3131
Mailing Address - Street 1:1063 HOPE ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06907-2109
Mailing Address - Country:US
Mailing Address - Phone:203-540-5155
Mailing Address - Fax:203-540-5111
Practice Address - Street 1:1063 HOPE ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06907-2109
Practice Address - Country:US
Practice Address - Phone:203-540-5155
Practice Address - Fax:203-540-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1228111NS0005X
CT1957111NS0005X
CT1883111NS0005X
CT1685111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty