Healthcare Provider Details

I. General information

NPI: 1457663270
Provider Name (Legal Business Name): T. H. GREEN CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2010
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 US HIGHWAY 160 WEST SOUTH RIDGE PLAZA, SUITE 215
WEST PLAINS MO
65775-7669
US

IV. Provider business mailing address

1134 W. MAPLEWOOD ST.
SPRINGFIELD MO
65807-4763
US

V. Phone/Fax

Practice location:
  • Phone: 417-257-1184
  • Fax:
Mailing address:
  • Phone: 417-522-9395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number005235
License Number StateMO

VIII. Authorized Official

Name: DR. THOMAS HOWARD GREEN
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 417-522-9395