Provider Demographics
NPI:1598778847
Name:GREENE, MATTHEW A (DC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:A
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 1:133 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT89087Medicare UPIN
OH0651851Medicare ID - Type Unspecified