Healthcare Provider Details

I. General information

NPI: 1669893418
Provider Name (Legal Business Name): JASON GREEN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7726 CENTER BLVD SE SUITE 125
SNOQUALMIE WA
98065-8748
US

IV. Provider business mailing address

7726 CENTER BLVD SE SUITE 125
SNOQUALMIE WA
98065-8748
US

V. Phone/Fax

Practice location:
  • Phone: 425-396-0613
  • Fax: 425-396-0614
Mailing address:
  • Phone: 425-396-0613
  • Fax: 425-396-0614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH60090924
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License NumberCH60070039
License Number StateWA

VIII. Authorized Official

Name: DR. JASON GREEN
Title or Position: OWNER
Credential: DC
Phone: 425-396-0613