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General NPI Number Information
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NPI Number | 1639949563
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Entity Type | Organization
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Legal Business Name | GREEN OAK FOREST LLC
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Dates
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Enumeration Date | 01/02/2024
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 291 S PRESTON RD STE 910
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City | PROSPER
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State | TX
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Zip | 75078-1913
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Country | US
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Telephone | 972-694-5888
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Fax | 972-694-5899
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Provider Business Mailing Address
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Address Line | 291 S PRESTON RD STE 910
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City | PROSPER
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State | TX
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Zip | 75078-1913
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Country | US
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Telephone | 972-694-5888
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Fax | 972-694-5899
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHENEY WANG
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Credential | DC
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Telephone | 469-274-7909
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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 |
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License Number State |
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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 |
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License Number State |
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