Healthcare Provider Details

I. General information

NPI: 1821727652
Provider Name (Legal Business Name): JENNIFER RENEE GREEN DC, ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E ROOSEVELT RD BLDG B
LOMBARD IL
60148-4539
US

IV. Provider business mailing address

1577 ROSE BLVD
BUFFALO GROVE IL
60089-3200
US

V. Phone/Fax

Practice location:
  • Phone: 630-889-6453
  • Fax: 630-889-6843
Mailing address:
  • Phone: 847-370-6919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number099.0082912
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.013866
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: