Provider Demographics
NPI:1235230897
Name:GREENBRIER CHIROPRACTIC CENTER, INC.
Entity type:Organization
Organization Name:GREENBRIER CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-645-6080
Mailing Address - Street 1:HC 82 BOX 10
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9501
Mailing Address - Country:US
Mailing Address - Phone:304-645-6080
Mailing Address - Fax:304-645-2825
Practice Address - Street 1:HC 82 BOX 10
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9501
Practice Address - Country:US
Practice Address - Phone:304-645-6080
Practice Address - Fax:304-645-2825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131742000Medicaid
WV0131742000Medicaid