Provider Demographics
NPI:1477032134
Name:MICHELE GREEN DC PC
Entity Type:Organization
Organization Name:MICHELE GREEN DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-260-2113
Mailing Address - Street 1:1820 MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-4206
Mailing Address - Country:US
Mailing Address - Phone:319-260-2113
Mailing Address - Fax:319-260-2118
Practice Address - Street 1:1820 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-4206
Practice Address - Country:US
Practice Address - Phone:319-260-2113
Practice Address - Fax:319-260-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty