Provider Demographics
NPI:1821200460
Name:GREENE, ROBERT C (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
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 1:712 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47567-1231
Mailing Address - Country:US
Mailing Address - Phone:812-354-6807
Mailing Address - Fax:812-354-3036
Practice Address - Street 1:712 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47567-1231
Practice Address - Country:US
Practice Address - Phone:812-354-6807
Practice Address - Fax:812-354-3036
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001548A111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200030600Medicaid
ININ1016 ORGANIZATIONMedicare PIN
IN200030600Medicaid