MEDICARE: CARROLL JEAN GREEN PA 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	13366	TX

General Provider Information

NPI Number	:	1114905015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARROLL JEAN GREEN PA C

Provider Business Mailing Address
First Line	:	6518 MORNINGSAGE LN
Second Line	:	SUITE 620
City	:	HOUSTON
State	:	TX
Zip	:	77088-6057
Country	:	US
Telephone Number	:	832-969-6744
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 S LOOP W
Second Line	:	SUITE 620
City	:	HOUSTON
State	:	TX
Zip	:	77054-2653
Country	:	US
Telephone Number	:	713-661-7246
Fax Number	:	713-661-7248

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

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	01/03/2017

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Directions to “ CARROLL JEAN GREEN PA C” Practice Location

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