Provider Demographics
NPI:1629012711
Name:GREENE, MICHAEL SMITH (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SMITH
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 1:529 SE 2ND ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-2646
Mailing Address - Country:US
Mailing Address - Phone:816-246-4884
Mailing Address - Fax:816-246-4884
Practice Address - Street 1:529 SE 2ND ST
Practice Address - Street 2:SUITE C
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2646
Practice Address - Country:US
Practice Address - Phone:816-246-4884
Practice Address - Fax:816-246-4884
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE004130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO001414Medicare ID - Type Unspecified