Provider Demographics
NPI:1669655643
Name:GREENE CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:GREENE CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-375-1590
Mailing Address - Street 1:267 HORSE THIEF LN
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-3106
Mailing Address - Country:US
Mailing Address - Phone:970-375-1590
Mailing Address - Fax:970-375-1584
Practice Address - Street 1:1145 S CAMINO DEL RIO
Practice Address - Street 2:SUITE 120
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6811
Practice Address - Country:US
Practice Address - Phone:970-375-1590
Practice Address - Fax:970-375-1584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4676111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC811498Medicare PIN