Provider Demographics
NPI:1215384276
Name:GREEN, BRIAN DOUGLAS II (DC)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DOUGLAS
Last Name:GREEN
Suffix:II
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 1:205 CENTRAL PARK LN STE A
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-1156
Mailing Address - Country:US
Mailing Address - Phone:864-788-1002
Mailing Address - Fax:864-788-1004
Practice Address - Street 1:205 CENTRAL PARK LN STE A
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-1156
Practice Address - Country:US
Practice Address - Phone:864-788-1002
Practice Address - Fax:864-788-1004
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4149111N00000X, 111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No111N00000XChiropractic ProvidersChiropractor