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General NPI Number Information
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NPI Number | 1770777591
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Entity Type | Organization
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Legal Business Name | GREEN CHIROPRACTIC OFFICES PC
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 09/05/2007
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Provider Practice Location Address
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Address Line | 133 SYLVAN ST
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City | DANVERS
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State | MA
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Zip | 01923
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Country | US
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Telephone | 978-777-0918
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Fax | 978-774-7521
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Provider Business Mailing Address
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Address Line | 133 SYLVAN ST
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City | DANVERS
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State | MA
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Zip | 01923
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Country | US
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Telephone | 978-777-0918
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Fax | 978-774-7521
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Authorized Official
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Title or Position | CHIROPRACTIC
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Name | MICHAEL EDWARD GREEN
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Credential | DC
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Telephone | 978-777-0918
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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 | 482
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License Number State | ME
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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 | 451
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License Number State | MA
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