Organization
GREENVILLE REHAB & PAIN CLINIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW RAY CHENAULT D. C. (OWNER)
(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
111N00000X
Chiropractor
Primary
042.618745
IL
225100000X
Physical Therapist
042618745
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0332010
BCBS
IL
Enumeration date
03/28/2007
Last updated
03/09/2009
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