Provider Demographics
NPI:1104425156
Name:GREENWELL FAMILY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:GREENWELL FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:EVE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GREENWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:217-412-7159
Mailing Address - Street 1:143 N HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:MT ZION
Mailing Address - State:IL
Mailing Address - Zip Code:62549-1313
Mailing Address - Country:US
Mailing Address - Phone:217-412-7159
Mailing Address - Fax:
Practice Address - Street 1:143 N HENDERSON ST
Practice Address - Street 2:
Practice Address - City:MT ZION
Practice Address - State:IL
Practice Address - Zip Code:62549-1313
Practice Address - Country:US
Practice Address - Phone:217-412-7159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty