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General NPI Number Information
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NPI Number | 1821727652
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Entity Type | Individual
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Provider Name | JENNIFER RENEE GREEN DC, ND
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Gender | Female
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Dates
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Enumeration Date | 06/07/2022
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 200 E ROOSEVELT RD BLDG B
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City | LOMBARD
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State | IL
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Zip | 60148-4539
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Country | US
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Telephone | 630-889-6453
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Fax | 630-889-6843
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Provider Business Mailing Address
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Address Line | 1577 ROSE BLVD
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-3200
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Country | US
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Telephone | 847-370-6919
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Fax |
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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 | 175F00000X
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Taxonomy Name | Naturopath
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License Number | 099.0082912
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License Number State | VT
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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 | 038.013866
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License Number State | IL
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