MEDICARE: DR. BARRY STEVEN GREENE CHIROPRACTOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CHIROO2645	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CHIROO2645	OTHER	GA	LICENSE NO.

General Provider Information

NPI Number	:	1831141308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY STEVEN GREENE CHIROPRACTOR

Provider Business Mailing Address
First Line	:	2840 MAIN ST W
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-3156
Country	:	US
Telephone Number	:	770-985-9021
Fax Number	:

Provider Business Practice Location Address
First Line	:	2840 MAIN ST W
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-3156
Country	:	US
Telephone Number	:	770-985-9021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	10/17/2016

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