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General NPI Number Information
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NPI Number | 1255464111
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Entity Type | Organization
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Legal Business Name | GREEN CHIROPRACTIC CORRECTIONS
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 18460 WRIGHT ST STE 9
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City | OMAHA
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State | NE
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Zip | 68130-2889
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Country | US
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Telephone | 402-933-5392
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Fax |
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Provider Business Mailing Address
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Address Line | 18460 WRIGHT ST STE 9
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City | OMAHA
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State | NE
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Zip | 68130-2889
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Country | US
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Telephone | 402-933-5392
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Fax |
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. TERESHEL M JOHNSON
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Credential | D.C.
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Telephone | 402-933-5392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 1384
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License Number State | NE
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