Healthcare Provider Details

I. General information

NPI: 1699863571
Provider Name (Legal Business Name): BACK & NECK PAIN CENTER OF GREENWICH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MELROSE AVE SUITE 101
GREENWICH CT
06830-6257
US

IV. Provider business mailing address

100 MELROSE AVE SUITE 101
GREENWICH CT
06830-6257
US

V. Phone/Fax

Practice location:
  • Phone: 203-629-0202
  • Fax: 203-629-0765
Mailing address:
  • Phone: 203-629-0202
  • Fax: 203-629-0765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number989
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. ADRIAN M MARCUS
Title or Position: PRESIDENT
Credential: DC
Phone: 203-629-0202