=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194896886
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREENVILLE CHIROPRACTIC INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | N1734 MUNICIPAL DR
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54942-8721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-757-9999
-----------------------------------------------------
Fax | 920-364-0237
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | N1734 MUNICIPAL DR
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54942-8721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-757-9999
-----------------------------------------------------
Fax | 920-364-0237
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT- OWNER
-----------------------------------------------------
Name | MR. PATRICK SHANNON DEWAR
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 920-757-9999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 3297
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------