Provider Demographics
NPI:1891702916
Name:GREEN RUN CHIROPRACTIC
Entity Type:Organization
Organization Name:GREEN RUN CHIROPRACTIC
Other - Org Name:GREEN RUN CHIROPRACTIC CLINIC, P.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:SUSANNE
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-468-5444
Mailing Address - Street 1:1190 LYNNHAVEN PKWY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4814
Mailing Address - Country:US
Mailing Address - Phone:757-468-5444
Mailing Address - Fax:757-468-2091
Practice Address - Street 1:1190 LYNNHAVEN PKWY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4814
Practice Address - Country:US
Practice Address - Phone:757-468-5444
Practice Address - Fax:757-468-2091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty