Provider Demographics
NPI:1053338574
Name:GREENFIELD CHIROPRACTIC, L.L.C.
Entity type:Organization
Organization Name:GREENFIELD CHIROPRACTIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-981-1992
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45123-0011
Mailing Address - Country:US
Mailing Address - Phone:937-981-1992
Mailing Address - Fax:937-981-1992
Practice Address - Street 1:1460 JEFFERSON STREET
Practice Address - Street 2:SUITE A
Practice Address - City:GREENFIELD
Practice Address - State:OH
Practice Address - Zip Code:45123
Practice Address - Country:US
Practice Address - Phone:937-981-1992
Practice Address - Fax:937-981-1992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3615111N00000X
OH1539111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5673904OtherFIRST HEALTH GROUP NUMBER
OH7638742OtherAETNA GROUP NUMBER
OH5673904OtherFIRST HEALTH GROUP NUMBER
OH5673904OtherFIRST HEALTH GROUP NUMBER