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General NPI Number Information
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NPI Number | 1093861759
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Entity Type | Organization
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Legal Business Name | GREEN CHIROPRACTIC
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 4030 MASSILLON RD STE C
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City | UNIONTOWN
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State | OH
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Zip | 44685-7867
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Country | US
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Telephone | 330-896-3366
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Fax |
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Provider Business Mailing Address
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Address Line | 4030 MASSILLON RD STE C
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City | UNIONTOWN
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State | OH
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Zip | 44685-7867
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Country | US
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Telephone | 330-896-3366
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RYAN CHURCH
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Credential | D.C.
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Telephone | 330-896-3366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 3408
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License Number State | OH
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