Provider Demographics
NPI:1346386802
Name:GREENE, JOEL CURTIS JR (DC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:CURTIS
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:PO BOX 693
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-0693
Mailing Address - Country:US
Mailing Address - Phone:803-259-9221
Mailing Address - Fax:803-259-3616
Practice Address - Street 1:11022 ELLENTON STREET
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812
Practice Address - Country:US
Practice Address - Phone:803-259-9221
Practice Address - Fax:803-259-3616
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1241111N00000X
MI006711111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC570937467OtherBLUE CROSS BLUE SHIELD