Provider Demographics
NPI:1275591331
Name:GREENE, PAUL T JR (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:T
Last Name:GREENE
Suffix:JR
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 1:2100 KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-2516
Mailing Address - Country:US
Mailing Address - Phone:620-792-1386
Mailing Address - Fax:
Practice Address - Street 1:2100 KANSAS AVE
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-2516
Practice Address - Country:US
Practice Address - Phone:620-792-1386
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-03194111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSPTT43937Medicare UPIN
KS023696Medicare ID - Type Unspecified