Provider Demographics
NPI:1821131418
Name:GREENE, STUART H (DC)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:H
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 1:1507 STILLWATER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-7358
Mailing Address - Country:US
Mailing Address - Phone:307-637-7463
Mailing Address - Fax:307-778-9814
Practice Address - Street 1:1507 STILLWATER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7358
Practice Address - Country:US
Practice Address - Phone:307-637-7463
Practice Address - Fax:307-778-9814
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYP00857345Medicare PIN
WYW23349Medicare PIN