Healthcare Provider Details

I. General information

NPI: 1609861889
Provider Name (Legal Business Name): MICHAEL EDWARD GREEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 SYLVAN ST
DANVERS MA
01923
US

IV. Provider business mailing address

133 SYLVAN ST
DANVERS MA
01923
US

V. Phone/Fax

Practice location:
  • Phone: 978-777-0918
  • Fax: 978-774-7521
Mailing address:
  • Phone: 978-777-0918
  • Fax: 978-774-7521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number451
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number482
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: