Provider Demographics
NPI:1194896886
Name:GREENVILLE CHIROPRACTIC INC.
Entity type:Organization
Organization Name:GREENVILLE CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT- OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:SHANNON
Authorized Official - Last Name:DEWAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-757-9999
Mailing Address - Street 1:N1734 MUNICIPAL DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54942-8721
Mailing Address - Country:US
Mailing Address - Phone:920-757-9999
Mailing Address - Fax:920-364-0237
Practice Address - Street 1:N1734 MUNICIPAL DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:WI
Practice Address - Zip Code:54942-8721
Practice Address - Country:US
Practice Address - Phone:920-757-9999
Practice Address - Fax:920-364-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3297111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI=========Medicaid