Provider Demographics
NPI:1821179748
Name:GRECO CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:GRECO CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNDON
Authorized Official - Middle Name:WILLIAM-MERCER
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:916-691-3900
Mailing Address - Street 1:6624 LAGUNA BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-5265
Mailing Address - Country:US
Mailing Address - Phone:916-691-3900
Mailing Address - Fax:916-691-3902
Practice Address - Street 1:6624 LAGUNA BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5265
Practice Address - Country:US
Practice Address - Phone:916-691-3900
Practice Address - Fax:916-691-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0263920Medicare ID - Type Unspecified