Provider Demographics
NPI:1710160312
Name:GREENWOOD CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:GREENWOOD CHIROPRACTIC, INC.
Other - Org Name:PERFORMANCE CHIROPRACTIC AND SPORTS REHAB.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:ORIGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, ATC
Authorized Official - Phone:317-884-0995
Mailing Address - Street 1:1185 W COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-5156
Mailing Address - Country:US
Mailing Address - Phone:317-884-0995
Mailing Address - Fax:317-882-7882
Practice Address - Street 1:1185 W COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-5156
Practice Address - Country:US
Practice Address - Phone:317-884-0995
Practice Address - Fax:317-882-7882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001958A111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN168260Medicare PIN
INU82305Medicare UPIN