# GRPC WELLNESS CLINIC SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366861155
- **Authorized official:** DR. MATTHEW R CHENAULT DC (OWNER/CEO)
- **Authorized official phone:** (618) 664-4600

## Contact information

- **Practice address:** 1105 E HARRIS AVE, GREENVILLE, IL 62246-2221
- **Practice address phone:** (618) 664-4600
- **Practice address fax:** (618) 664-2136
- **Mailing address:** 1105 E HARRIS AVE, GREENVILLE, IL 62246-2221
- **Mailing address phone:** (618) 664-4600
- **Mailing address fax:** (618) 664-2136

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NR0400X | Rehabilitation Chiropractor | 038.010373 | IL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | 038.010373 | IL | Yes |

## Other

- **Enumeration date:** 04/09/2014
- **Last updated:** 04/09/2014