Provider Demographics
NPI:1346572427
Name:DR JAMES A GREEN PC
Entity Type:Organization
Organization Name:DR JAMES A GREEN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-525-3630
Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-0878
Mailing Address - Country:US
Mailing Address - Phone:816-525-3630
Mailing Address - Fax:816-524-3630
Practice Address - Street 1:400 SE 3RD ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64063-2823
Practice Address - Country:US
Practice Address - Phone:816-525-3630
Practice Address - Fax:816-524-3630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0004297Medicare PIN
MOT73735Medicare UPIN