Provider Demographics
NPI:1164572202
Name:GREEN, WILLIAM EDWARD JR (DC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:GREEN
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:EDWARD
Other - Last Name:GREEN
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:310 PARKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORMANDY
Mailing Address - State:TN
Mailing Address - Zip Code:37360
Mailing Address - Country:US
Mailing Address - Phone:931-857-9454
Mailing Address - Fax:931-857-9450
Practice Address - Street 1:310 PARKS DRIVE
Practice Address - Street 2:
Practice Address - City:NORMANDY
Practice Address - State:TN
Practice Address - Zip Code:37360
Practice Address - Country:US
Practice Address - Phone:931-857-9454
Practice Address - Fax:931-857-9450
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC212111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0015465OtherBCBS
T74474Medicare UPIN
TN3671892Medicare ID - Type Unspecified