Healthcare Provider Details

I. General information

NPI: 1215384276
Provider Name (Legal Business Name): BRIAN DOUGLAS GREEN II D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 CENTRAL PARK LN STE A
SENECA SC
29678-1156
US

IV. Provider business mailing address

205 CENTRAL PARK LN STE A
SENECA SC
29678-1156
US

V. Phone/Fax

Practice location:
  • Phone: 864-788-1002
  • Fax: 864-788-1004
Mailing address:
  • Phone: 864-788-1002
  • Fax: 864-788-1004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4149
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number4149
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: