Provider Demographics
NPI:1295910263
Name:FLORENCE CHIROPRACTIC CLINIC, P.C.
Entity type:Organization
Organization Name:FLORENCE CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:541-997-6909
Mailing Address - Street 1:PO BOX 2296
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-0148
Mailing Address - Country:US
Mailing Address - Phone:541-997-6909
Mailing Address - Fax:541-997-5212
Practice Address - Street 1:1690 15TH STREET
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-0148
Practice Address - Country:US
Practice Address - Phone:541-997-6909
Practice Address - Fax:541-997-5212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000QGDDJMedicare PIN
ORT67982Medicare UPIN