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General NPI Number Information
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NPI Number | 1609414887
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Entity Type | Organization
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Legal Business Name | GREATER GREENVILLE CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 12/18/2019
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 205 BRYCE CIR STE A
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-4842
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Country | US
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Telephone | 941-586-2758
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Fax |
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Provider Business Mailing Address
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Address Line | 1431 TORINO ST
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City | NORTH PORT
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State | FL
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Zip | 34287-3987
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Country | US
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Telephone | 941-586-2758
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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. GREGORY LEE SMITH
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Credential | D.C.
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Telephone | 941-586-2758
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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 |
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