Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 14078 | CA |
NPI | 1144245119 |
---|---|
Provider Name | Dr. John Christopher Greene |
First Address | Irvine, CA 92620-3600 |
Second Address | Irvine, CA 92620-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 08/07/2007 |