Provider Demographics
NPI:1811197759
Name:GREENVILLE CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:GREENVILLE CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALEY
Authorized Official - Suffix:
Authorized Official - Credentials:OM, CA
Authorized Official - Phone:662-335-2855
Mailing Address - Street 1:1654 SOUTH COLORADO STREET
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38703
Mailing Address - Country:US
Mailing Address - Phone:662-335-2854
Mailing Address - Fax:662-335-0502
Practice Address - Street 1:1654 SOUTH COLORADO STREET
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-7216
Practice Address - Country:US
Practice Address - Phone:662-335-2854
Practice Address - Fax:662-335-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS794111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSC9016212Medicaid
MSC9016212Medicaid