Provider Demographics
NPI:1154471407
Name:GREENE FAMILY CHIROPRACTIC PRACTICE
Entity Type:Organization
Organization Name:GREENE FAMILY CHIROPRACTIC PRACTICE
Other - Org Name:GREENE CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
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:937-840-9660
Mailing Address - Street 1:721 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-1434
Mailing Address - Country:US
Mailing Address - Phone:937-840-9660
Mailing Address - Fax:937-840-9669
Practice Address - Street 1:721 S HIGH ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1434
Practice Address - Country:US
Practice Address - Phone:937-840-9660
Practice Address - Fax:937-840-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1507111N00000X
OH2832111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2231409Medicaid
OH0758943Medicaid
OH2231409Medicaid
OHRE0877323Medicare ID - Type UnspecifiedMEDICARE
OH0758943Medicaid
OHGR0651852Medicare ID - Type UnspecifiedMEDICARE