MEDICARE: DR. BROOKE GREEN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	13362	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	13362	OTHER	TX	TEXAS BOARD OF CHIROPRACTIC EXAMINERS

General Provider Information

NPI Number	:	1063957157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BROOKE GREEN D.C.

Provider Business Mailing Address
First Line	:	PO BOX 700688
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78270-0688
Country	:	US
Telephone Number	:	210-477-7654
Fax Number	:	210-468-0682

Provider Business Practice Location Address
First Line	:	18818 MEISNER DR STE 107
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-3569
Country	:	US
Telephone Number	:	800-404-6050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2016
Last Update Date	:	11/22/2019

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Directions to “ DR. BROOKE GREEN D.C.” Practice Location

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