Provider Demographics
NPI:1568780708
Name:GREENE CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:GREENE CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:H
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-637-7463
Mailing Address - Street 1:1507 STILLWATER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-7358
Mailing Address - Country:US
Mailing Address - Phone:307-637-7463
Mailing Address - Fax:307-778-9814
Practice Address - Street 1:1507 STILLWATER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7358
Practice Address - Country:US
Practice Address - Phone:307-637-7463
Practice Address - Fax:307-778-9814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty