Provider Demographics
NPI:1144245119
Name:GREENE, JOHN CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTOPHER
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 1:4200 TRABUCO RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3600
Mailing Address - Country:US
Mailing Address - Phone:949-857-6631
Mailing Address - Fax:
Practice Address - Street 1:4200 TRABUCO RD
Practice Address - Street 2:SUITE 180
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-3600
Practice Address - Country:US
Practice Address - Phone:949-857-6631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14078111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician