Healthcare Provider Details

I. General information

NPI: 1760154033
Provider Name (Legal Business Name): TERESA A GREEN DC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 OLD RICHMOND AVE STE A4
RICHMOND VA
23226-1828
US

IV. Provider business mailing address

5700 OLD RICHMOND AVE STE A4
RICHMOND VA
23226-1828
US

V. Phone/Fax

Practice location:
  • Phone: 804-477-3194
  • Fax: 804-477-3324
Mailing address:
  • Phone: 804-477-3194
  • Fax: 804-477-3324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. TERESA GREEN
Title or Position: OWNER/CHIROPRACTOR
Credential: DC
Phone: 804-477-3194