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General NPI Number Information
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NPI Number | 1205009206
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Entity Type | Organization
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Legal Business Name | GREENE SPECIFIC CHIROPRACTIC CLINIC PC
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 08/03/2015
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Provider Practice Location Address
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Address Line | 712 E MAIN ST
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City | PETERSBURG
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State | IN
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Zip | 47567-1231
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Country | US
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Telephone | 812-354-6807
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Fax | 812-354-3036
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Provider Business Mailing Address
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Address Line | 712 E MAIN ST
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City | PETERSBURG
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State | IN
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Zip | 47567-1231
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Country | US
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Telephone | 812-354-6807
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Fax | 812-354-3036
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT C. GREENE
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Credential | DC
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Telephone | 812-354-6807
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 08001548A
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License Number State | IN
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