Provider Demographics
NPI:1437595535
Name:EBNER CHIRORPACTIC PA
Entity Type:Organization
Organization Name:EBNER CHIRORPACTIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:EBNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-644-2700
Mailing Address - Street 1:2108 LAURENS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3222
Mailing Address - Country:US
Mailing Address - Phone:864-616-2675
Mailing Address - Fax:
Practice Address - Street 1:2108 LAURENS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3222
Practice Address - Country:US
Practice Address - Phone:864-616-2675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3750111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC3750OtherMEDICAL LICENSE