Provider Demographics
NPI:1083013759
Name:GREENE, SARAH C (LAC, DIPL AC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:C
Last Name:GREENE
Suffix:
Gender:F
Credentials:LAC, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-4734
Mailing Address - Country:US
Mailing Address - Phone:812-345-0368
Mailing Address - Fax:
Practice Address - Street 1:2321 N FRITZ DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-1330
Practice Address - Country:US
Practice Address - Phone:812-345-0368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000157A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist