Provider Demographics
NPI:1255464111
Name:GREEN CHIROPRACTIC CORRECTIONS
Entity Type:Organization
Organization Name:GREEN CHIROPRACTIC CORRECTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESHEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-933-5392
Mailing Address - Street 1:18460 WRIGHT ST STE 9
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-2889
Mailing Address - Country:US
Mailing Address - Phone:402-933-5392
Mailing Address - Fax:
Practice Address - Street 1:18460 WRIGHT ST STE 9
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2889
Practice Address - Country:US
Practice Address - Phone:402-933-5392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1384111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025294100Medicaid
NE10025294100Medicaid