Provider Demographics
NPI:1326125451
Name:GREEN, TOBY CHARLES (DC)
Entity Type:Individual
Prefix:DR
First Name:TOBY
Middle Name:CHARLES
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 1:5314 S 190TH TER
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-4107
Mailing Address - Country:US
Mailing Address - Phone:402-212-1470
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025294100Medicaid
NE09698OtherBCBS
NE247128OtherMIDLANDS CHOICE
NE279185Medicare ID - Type Unspecified