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General NPI Number Information
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NPI Number | 1477614519
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Entity Type | Organization
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Legal Business Name | DR REBECCA GREEN
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 121 BROADWAY SUITE 2
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City | COLCHESTER
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State | CT
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Zip | 06415
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Country | US
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Telephone | 860-537-8900
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Fax | 860-537-8868
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Provider Business Mailing Address
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Address Line | 121 BROADWAY SUITE 2
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City | COLCHESTER
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State | CT
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Zip | 06415
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Country | US
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Telephone | 860-537-8900
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Fax | 860-537-8868
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Authorized Official
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Title or Position | OWNER
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Name | DR. REBECCA A GREEN
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Credential | DC DACBSP
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Telephone | 860-537-8900
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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 | 0CP00506
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 001023
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License Number State | CT
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