MEDICARE: DR. TERESA A 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	0104556283	VA

General Provider Information

NPI Number	:	1255395661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA A GREEN D.C.

Provider Business Mailing Address
First Line	:	PO BOX 293
Second Line	:
City	:	GUM SPRING
State	:	VA
Zip	:	23065-0293
Country	:	US
Telephone Number	:	804-477-3194
Fax Number	:	804-477-3324

Provider Business Practice Location Address
First Line	:	5700 OLD RICHMOND AVE STE A4
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-1828
Country	:	US
Telephone Number	:	804-477-3194
Fax Number	:	804-477-3324

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	10/26/2022

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