Provider Demographics
NPI:1598707879
Name:CHIROPRACTIC CENTER OF GREATER GREENVILLE
Entity Type:Organization
Organization Name:CHIROPRACTIC CENTER OF GREATER GREENVILLE
Other - Org Name:UPSTATE CHIROPRACTIC CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOOLSBY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-288-9989
Mailing Address - Street 1:2092B WOODRUFF RD
Mailing Address - Street 2:WOODRUFF PROFESSIONAL PARK
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5939
Mailing Address - Country:US
Mailing Address - Phone:864-288-9989
Mailing Address - Fax:
Practice Address - Street 1:2092B WOODRUFF RD
Practice Address - Street 2:WOODRUFF PROFESSIONAL PARK
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5939
Practice Address - Country:US
Practice Address - Phone:864-288-9989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3001111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00413494OtherRR MEDICARE PTAN
SCDG0764OtherRR MEDICARE GROUP
SCP00413494OtherRR MEDICARE PTAN
SCAA08478423Medicare UPIN