Provider Demographics
NPI:1770670671
Name:GREENE-DAVIS ENTERPRISES, LLC
Entity Type:Organization
Organization Name:GREENE-DAVIS ENTERPRISES, LLC
Other - Org Name:LOW BACK SOLUTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-228-5179
Mailing Address - Street 1:1200 NW SOUTH OUTER RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64015-3072
Mailing Address - Country:US
Mailing Address - Phone:816-228-5179
Mailing Address - Fax:816-246-4884
Practice Address - Street 1:1200 NW SOUTH OUTER RD
Practice Address - Street 2:SUITE 116
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-3072
Practice Address - Country:US
Practice Address - Phone:816-228-5179
Practice Address - Fax:816-246-4884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCE004130261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOD08608428OtherDME
MOD08608428OtherDME