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General NPI Number Information
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NPI Number | 1871780585
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Entity Type | Organization
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Legal Business Name | GREENWICH SPORTS MEDICINE PC
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 10 GLENVILLE ST STE 3
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City | GREENWICH
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State | CT
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Zip | 06831-3680
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Country | US
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Telephone | 203-531-3131
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Fax | 203-531-5690
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Provider Business Mailing Address
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Address Line | 10 GLENVILLE ST STE 3
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City | GREENWICH
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State | CT
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Zip | 06831-3680
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Country | US
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Telephone | 203-531-3131
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Fax | 203-531-5690
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KATIE ELISE LORENA KENNY
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Credential |
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Telephone | 203-531-3131
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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 | 1228
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License Number State | CT
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