Provider Demographics
NPI:1417055401
Name:GREENE, TYLER B (DC)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:B
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:P.O. BOX 1645
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93902-1645
Mailing Address - Country:US
Mailing Address - Phone:831-757-9411
Mailing Address - Fax:831-422-4677
Practice Address - Street 1:21 WINHAM STREET
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3314
Practice Address - Country:US
Practice Address - Phone:831-757-9411
Practice Address - Fax:831-422-4677
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14079111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0140790Medicare UPIN
T05234Medicare UPIN