1154471407 NPI number — GREENE FAMILY CHIROPRACTIC PRACTICE

Table of content: (NPI 1154471407)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154471407 NPI number — GREENE FAMILY CHIROPRACTIC PRACTICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREENE FAMILY CHIROPRACTIC PRACTICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154471407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
721 S HIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILLSBORO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45133-1434
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-840-9660
Provider Business Mailing Address Fax Number:
937-840-9669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 S HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45133-1434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-840-9660
Provider Business Practice Location Address Fax Number:
937-840-9669
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GREENE
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
937-840-9660

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  1507 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111N00000X , with the licence number: 2832 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2231409 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0758943 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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