Provider Demographics
NPI:1265892103
Name:GREENE, MICHAEL JOEL (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOEL
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:PO BOX 1646
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42419-1646
Mailing Address - Country:US
Mailing Address - Phone:270-826-1077
Mailing Address - Fax:270-826-2572
Practice Address - Street 1:490 KLUTEY PARK PLAZA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3348
Practice Address - Country:US
Practice Address - Phone:270-826-1077
Practice Address - Fax:270-826-2572
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor