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General NPI Number Information
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NPI Number | 1548478449
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Entity Type | Organization
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Legal Business Name | THE PAIN RELIEF CENTER OF GREENVILLE, P.C.
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 555 E HARRIS AVE
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City | GREENVILLE
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State | IL
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Zip | 62246-2213
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Country | US
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Telephone | 618-664-0111
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Fax |
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Provider Business Mailing Address
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Address Line | 555 E HARRIS AVE
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City | GREENVILLE
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State | IL
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Zip | 62246-2213
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | JEREMY R CLARK
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Credential |
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Telephone | 618-664-0111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State | IL
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