Provider Demographics
NPI:1770763369
Name:GREEN VALLEY CHIROPRACTIC CENTER INC.
Entity type:Organization
Organization Name:GREEN VALLEY CHIROPRACTIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:KING
Authorized Official - Suffix:SR
Authorized Official - Credentials:DC
Authorized Official - Phone:520-648-2225
Mailing Address - Street 1:380 W VISTA HERMOSA DR
Mailing Address - Street 2:SUITE #100
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-1999
Mailing Address - Country:US
Mailing Address - Phone:520-648-2225
Mailing Address - Fax:520-625-9777
Practice Address - Street 1:380 W VISTA HERMOSA DR
Practice Address - Street 2:SUITE #100
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-1999
Practice Address - Country:US
Practice Address - Phone:520-648-2225
Practice Address - Fax:520-625-9777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty