Provider Demographics
NPI:1790805315
Name:GREEN, CAROL LOUISE (DC)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:LOUISE
Last Name:GREEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 S COAST HIGHWAY 101
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3530
Mailing Address - Country:US
Mailing Address - Phone:760-942-6022
Mailing Address - Fax:760-942-6022
Practice Address - Street 1:463 S COAST HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3530
Practice Address - Country:US
Practice Address - Phone:760-942-6022
Practice Address - Fax:760-942-6022
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC17480111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor