Provider Demographics
NPI:1699863571
Name:BACK & NECK PAIN CENTER OF GREENWICH, P.C.
Entity type:Organization
Organization Name:BACK & NECK PAIN CENTER OF GREENWICH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-629-0202
Mailing Address - Street 1:100 MELROSE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6257
Mailing Address - Country:US
Mailing Address - Phone:203-629-0202
Mailing Address - Fax:203-629-0765
Practice Address - Street 1:100 MELROSE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6257
Practice Address - Country:US
Practice Address - Phone:203-629-0202
Practice Address - Fax:203-629-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT989111N00000X
225100000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty