Provider Demographics
NPI:1083624845
Name:GREEN, THOMAS H (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:GREEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 W MAPLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4763
Mailing Address - Country:US
Mailing Address - Phone:417-886-8133
Mailing Address - Fax:
Practice Address - Street 1:1713 W US HIGHWAY 160
Practice Address - Street 2:SUITE 215
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-7669
Practice Address - Country:US
Practice Address - Phone:417-257-1184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005235111N00000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered111N00000XChiropractic ProvidersChiropractor
Not Answered171100000XOther Service ProvidersAcupuncturist