Provider Demographics
NPI:1730145798
Name:GREENE, KEVIN MEREDITH (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MEREDITH
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 1:38R ENON ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1166
Mailing Address - Country:US
Mailing Address - Phone:978-927-8466
Mailing Address - Fax:978-927-8486
Practice Address - Street 1:38R ENON ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1166
Practice Address - Country:US
Practice Address - Phone:978-927-8466
Practice Address - Fax:978-927-8486
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2048111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH05Y007500NH01OtherANTHEM
NH043413846OtherAETNA
MAY36442OtherBCBS
MA110030428AMedicaid
NH043413846OtherUNITEDHEALTHCARE
NH792998OtherTUFTS
NHU64126OtherHARVARD PILGRIM
NH566710OtherCIGNA
NH043413846OtherAETNA
NHU64126OtherHARVARD PILGRIM
NHU64126Medicare UPIN
MAY36442OtherBCBS