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General NPI Number Information
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NPI Number | 1306157029
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Entity Type | Organization
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Legal Business Name | GREEN CHIROPRACTIC, PC
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Dates
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Enumeration Date | 06/28/2010
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Last Update Date | 06/28/2010
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Provider Practice Location Address
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Address Line | 1214 W 43RD ST SUITE 400
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City | HOUSTON
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State | TX
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Zip | 77018-4235
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Country | US
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Telephone | 832-860-1796
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Fax |
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Provider Business Mailing Address
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Address Line | 1214 W 43RD ST SUITE 400
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City | HOUSTON
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State | TX
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Zip | 77018-4235
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Country | US
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Telephone | 832-860-1796
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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. GREGORY ALLEN GREEN
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Credential | D.C.
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Telephone | 832-860-1796
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 11465
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License Number State | TX
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