Provider Demographics
NPI:1750319083
Name:GREENE, DANIEL EDWARD (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EDWARD
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 1:1818 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:MI
Mailing Address - Zip Code:48756-8627
Mailing Address - Country:US
Mailing Address - Phone:989-873-4111
Mailing Address - Fax:989-873-6704
Practice Address - Street 1:1818 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:MI
Practice Address - Zip Code:48756-8627
Practice Address - Country:US
Practice Address - Phone:989-873-4111
Practice Address - Fax:989-873-6704
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDG006789111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1965690Medicaid
MI950F510360OtherBCBS NUMBER
MIT86579Medicare UPIN
MIOF550255952Medicare ID - Type UnspecifiedMEDICARE NUMBER