Provider Demographics
NPI:1851458707
Name:GREENE, KELLI RAE (DC)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:RAE
Last Name:GREENE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16214 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2901
Mailing Address - Country:US
Mailing Address - Phone:562-902-9292
Mailing Address - Fax:562-315-5266
Practice Address - Street 1:16214 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2901
Practice Address - Country:US
Practice Address - Phone:562-902-9292
Practice Address - Fax:562-315-5266
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU80015Medicare UPIN
CAWDC26629BMedicare ID - Type Unspecified
CAW15828Medicare ID - Type UnspecifiedGROUP NUMBER