Provider Demographics
NPI:1740339308
Name:GREAT RIVER CHIROPRACTIC CLINIC, LLC
Entity type:Organization
Organization Name:GREAT RIVER CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:410-683-8888
Mailing Address - Street 1:305 W CHESAPEAKE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-4421
Mailing Address - Country:US
Mailing Address - Phone:410-683-8888
Mailing Address - Fax:410-683-8822
Practice Address - Street 1:305 W CHESAPEAKE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4421
Practice Address - Country:US
Practice Address - Phone:410-683-8888
Practice Address - Fax:410-683-8822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty