1053338574 NPI number — GREENFIELD CHIROPRACTIC, L.L.C.

Table of content: (NPI 1053338574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053338574 NPI number — GREENFIELD CHIROPRACTIC, L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENFIELD CHIROPRACTIC, L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053338574
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 11
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45123-0011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-981-1992
Provider Business Mailing Address Fax Number:
937-981-1992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1460 JEFFERSON STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GREENFIELD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-981-1992
Provider Business Practice Location Address Fax Number:
937-981-1992
Provider Enumeration Date:
07/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REEVES
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
937-981-1992

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3615 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 1539 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5673904 . This is a "FIRST HEALTH GROUP NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7638742 . This is a "AETNA GROUP NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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