Healthcare Provider Details

I. General information

NPI: 1952743528
Provider Name (Legal Business Name): JESSICA MICHELLE GREENE ND, DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3211 HOLIDAY CT STE 201C
LA JOLLA CA
92037-1810
US

IV. Provider business mailing address

3211 HOLIDAY CT STE 201C
LA JOLLA CA
92037-1810
US

V. Phone/Fax

Practice location:
  • Phone: 858-287-0623
  • Fax:
Mailing address:
  • Phone: 858-287-0623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number938
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number32688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: