Provider Demographics
NPI:1952515207
Name:GREENE, RICHARD FRED (DC)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:FRED
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 1:300 WESTWARD DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5262
Mailing Address - Country:US
Mailing Address - Phone:305-883-5200
Mailing Address - Fax:305-883-5200
Practice Address - Street 1:300 WESTWARD DR
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-5262
Practice Address - Country:US
Practice Address - Phone:305-883-5200
Practice Address - Fax:305-883-5200
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0004933111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL70942Medicare ID - Type Unspecified