Provider Demographics
NPI:1306960463
Name:GREENE, CHRISTOPHER R (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:R
Last Name:GREENE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9252 HIDDEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:92861-2306
Mailing Address - Country:US
Mailing Address - Phone:714-949-0724
Mailing Address - Fax:
Practice Address - Street 1:2300 FOOTHILL BLVD
Practice Address - Street 2:STE A
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-3064
Practice Address - Country:US
Practice Address - Phone:909-392-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCHR-4676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU87281Medicare UPIN
CO811499Medicare PIN