Provider Demographics
NPI:1295487296
Name:GREATER CHIROPRACTIC LLC
Entity type:Organization
Organization Name:GREATER CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FUGA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-850-0813
Mailing Address - Street 1:23200 GREATER MACK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3422
Mailing Address - Country:US
Mailing Address - Phone:313-444-4146
Mailing Address - Fax:
Practice Address - Street 1:23200 GREATER MACK AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-3422
Practice Address - Country:US
Practice Address - Phone:586-850-0813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty