Provider Demographics
NPI:1437395985
Name:GREEN CHIROPRACTIC PC
Entity Type:Organization
Organization Name:GREEN CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:402-466-6454
Mailing Address - Street 1:1161 N COTNER BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-1835
Mailing Address - Country:US
Mailing Address - Phone:402-466-6454
Mailing Address - Fax:402-466-7829
Practice Address - Street 1:1161 N COTNER BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-1835
Practice Address - Country:US
Practice Address - Phone:402-466-6454
Practice Address - Fax:402-466-7829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-05
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE350056842OtherRAILROAD
NE47067810900Medicaid
NE36638OtherBLUE CROSS BLUE SHIELD
NET40205Medicare UPIN
NE47067810900Medicaid