Healthcare Provider Details

I. General information

NPI: 1770545402
Provider Name (Legal Business Name): PINE VALLEY CHIROPRACTIC CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4018 SALTSBURG RD
MURRYSVILLE PA
15668-9774
US

IV. Provider business mailing address

4018 SALTSBURG RD
MURRYSVILLE PA
15668-9774
US

V. Phone/Fax

Practice location:
  • Phone: 724-733-2225
  • Fax: 724-733-2500
Mailing address:
  • Phone: 724-733-2225
  • Fax: 724-733-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC007105L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC007205L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC006907L
License Number StatePA

VIII. Authorized Official

Name: DR. BRIAN R GREEN
Title or Position: PRESIDENT
Credential: DC
Phone: 724-733-2225