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General NPI Number Information
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NPI Number | 1568657229
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Entity Type | Organization
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Legal Business Name | GREENE CHIROPRACTIC BACK
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 09/06/2007
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Provider Practice Location Address
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Address Line | 2100 KANSAS AVE
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City | GREAT BEND
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State | KS
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Zip | 67530-2516
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Country | US
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Telephone | 620-792-1386
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Fax | 620-792-8634
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Provider Business Mailing Address
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Address Line | 2100 KANSAS AVE
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City | GREAT BEND
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State | KS
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Zip | 67530-2516
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Country | US
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Telephone | 620-792-1386
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Fax | 620-792-8634
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Authorized Official
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Title or Position | OWNER
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Name | DR. TOM PAUL GREENE
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Credential | DC
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Telephone | 620-792-1386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 01-03194
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License Number State | KS
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