Provider Demographics
NPI:1417376278
Name:GREENE CHIROPRACTIC CENTER, LLC
Entity type:Organization
Organization Name:GREENE CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DABCO
Authorized Official - Phone:937-587-2613
Mailing Address - Street 1:133 ELLIOTT AVE
Mailing Address - Street 2:
Mailing Address - City:PEEBLES
Mailing Address - State:OH
Mailing Address - Zip Code:45660-1027
Mailing Address - Country:US
Mailing Address - Phone:937-587-2613
Mailing Address - Fax:937-587-3911
Practice Address - Street 1:133 ELLIOTT AVE
Practice Address - Street 2:
Practice Address - City:PEEBLES
Practice Address - State:OH
Practice Address - Zip Code:45660-1027
Practice Address - Country:US
Practice Address - Phone:937-587-2613
Practice Address - Fax:937-587-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0937213Medicaid