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General NPI Number Information
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NPI Number | 1316238397
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Entity Type | Individual
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Provider Name | JUSTIN Z GREEN LAC
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Gender | Male
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 44 VILLAGE LOOP RD
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City | KALISPELL
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State | MT
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Zip | 59901-2793
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Country | US
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Telephone | 406-250-5786
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Fax | 406-848-6236
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Provider Business Mailing Address
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Address Line | 767 N MAIN ST
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City | KALISPELL
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State | MT
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Zip | 59901-3603
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Country | US
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Telephone | 406-250-5786
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Fax | 406-848-6236
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | MED-ACU-LIC-175
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License Number State | MT
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