Provider Demographics
NPI:1336647403
Name:CHIROPRO OF GLENED LLC DBA CHIROPRO OF TROY
Entity Type:Organization
Organization Name:CHIROPRO OF GLENED LLC DBA CHIROPRO OF TROY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BRANDON
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-979-0398
Mailing Address - Street 1:1231 THOUVENOT LN STE 100
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-7203
Mailing Address - Country:US
Mailing Address - Phone:618-692-9100
Mailing Address - Fax:
Practice Address - Street 1:220 E US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-2201
Practice Address - Country:US
Practice Address - Phone:618-692-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty