Provider Demographics
NPI:1871864025
Name:GREEN CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:GREEN CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:814-378-8582
Mailing Address - Street 1:5311 GREEN ACRE RD
Mailing Address - Street 2:
Mailing Address - City:HOUTZDALE
Mailing Address - State:PA
Mailing Address - Zip Code:16651-9428
Mailing Address - Country:US
Mailing Address - Phone:814-378-8582
Mailing Address - Fax:814-378-8606
Practice Address - Street 1:5311 GREEN ACRE RD
Practice Address - Street 2:
Practice Address - City:HOUTZDALE
Practice Address - State:PA
Practice Address - Zip Code:16651-9428
Practice Address - Country:US
Practice Address - Phone:814-378-8582
Practice Address - Fax:814-378-8606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001617L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty