Provider Demographics
NPI:1760083885
Name:GREEN CHIROPRACTIC & WELLNESS
Entity Type:Organization
Organization Name:GREEN CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-737-0662
Mailing Address - Street 1:22780 THREE NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-1538
Mailing Address - Country:US
Mailing Address - Phone:301-737-0662
Mailing Address - Fax:301-737-0675
Practice Address - Street 1:22780 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-1538
Practice Address - Country:US
Practice Address - Phone:301-737-0662
Practice Address - Fax:301-737-0675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty