Provider Demographics
NPI:1568550853
Name:GREYADOR, INC
Entity Type:Organization
Organization Name:GREYADOR, INC
Other - Org Name:CHIROPRACTIC SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VALLI
Authorized Official - Middle Name:M
Authorized Official - Last Name:GAMBINA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:941-492-6880
Mailing Address - Street 1:401 COMMERCIAL CT
Mailing Address - Street 2:STE E
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-1652
Mailing Address - Country:US
Mailing Address - Phone:941-492-6880
Mailing Address - Fax:941-492-6881
Practice Address - Street 1:401 COMMERCIAL CT
Practice Address - Street 2:STE E
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1652
Practice Address - Country:US
Practice Address - Phone:941-492-6880
Practice Address - Fax:941-492-6881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6599111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2509Medicare PIN