Provider Demographics
NPI:1174723654
Name:GREENE, WINSTON WALTON
Entity type:Individual
Prefix:DR
First Name:WINSTON
Middle Name:WALTON
Last Name:GREENE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:WINSTON
Other - Middle Name:W
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:5818 BEVERLY HILL ST.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-6710
Mailing Address - Country:US
Mailing Address - Phone:713-953-7500
Mailing Address - Fax:713-953-7503
Practice Address - Street 1:5818 BEVERLY HILL ST.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-6710
Practice Address - Country:US
Practice Address - Phone:713-953-7500
Practice Address - Fax:713-953-7503
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor