Provider Demographics
NPI:1699101527
Name:GREENSBORO SPORTS, SPINE, &
Entity type:Organization
Organization Name:GREENSBORO SPORTS, SPINE, &
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:LANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-991-5320
Mailing Address - Street 1:946 HARMONY RD
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-5877
Mailing Address - Country:US
Mailing Address - Phone:706-991-5320
Mailing Address - Fax:866-720-5313
Practice Address - Street 1:946 HARMONY RD
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-5877
Practice Address - Country:US
Practice Address - Phone:706-991-5320
Practice Address - Fax:866-720-5313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008739111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty