Healthcare Provider Details

I. General information

NPI: 1043497498
Provider Name (Legal Business Name): GREENEVILLE CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 MASON ST
GREENEVILLE TN
37745-4014
US

IV. Provider business mailing address

155 MASON ST
GREENEVILLE TN
37745-4014
US

V. Phone/Fax

Practice location:
  • Phone: 423-638-5361
  • Fax:
Mailing address:
  • Phone: 423-638-5361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC0000000104
License Number StateTN

VIII. Authorized Official

Name: MR. LEONARD HARTMAN
Title or Position: PRESIDENT/CEO
Credential: DC
Phone: 423-638-5361