Healthcare Provider Details

I. General information

NPI: 1770777591
Provider Name (Legal Business Name): GREEN CHIROPRACTIC OFFICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
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 TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number482
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number451
License Number StateMA

VIII. Authorized Official

Name: MICHAEL EDWARD GREEN
Title or Position: CHIROPRACTIC
Credential: DC
Phone: 978-777-0918