Provider Demographics
NPI:1770608572
Name:GREENE, KARA LEIGH (DC)
Entity type:Individual
Prefix:DR
First Name:KARA
Middle Name:LEIGH
Last Name:GREENE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 KNOLL RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2146
Mailing Address - Country:US
Mailing Address - Phone:860-347-2622
Mailing Address - Fax:
Practice Address - Street 1:576 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-3015
Practice Address - Country:US
Practice Address - Phone:860-233-1212
Practice Address - Fax:860-233-6565
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001485111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU94673Medicare UPIN