Organization
GRPC WELLNESS CLINIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW R CHENAULT DC (OWNER/CEO)
(618) 664-4600
Entity
Organization
Contact information
Practice address
1105 E HARRIS AVE, GREENVILLE, IL 62246-2221
(618) 664-4600
(618) 664-2136
Mailing address
1105 E HARRIS AVE, GREENVILLE, IL 62246-2221
(618) 664-4600
(618) 664-2136
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
038.010373
IL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
038.010373
IL
Other
Enumeration date
04/09/2014
Last updated
04/09/2014
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