Provider Demographics
NPI:1588617112
Name:GREENE, JAMES JEROME (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JEROME
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 1:805 NORTH MAIN STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-5476
Mailing Address - Country:US
Mailing Address - Phone:620-276-8284
Mailing Address - Fax:620-276-6653
Practice Address - Street 1:805 NORTH MAIN STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5476
Practice Address - Country:US
Practice Address - Phone:620-276-8284
Practice Address - Fax:620-276-6653
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104066111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS059962Medicare ID - Type Unspecified
U22160Medicare UPIN