Provider Demographics
NPI:1922312800
Name:THOMAS H. GREEN CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:THOMAS H. GREEN CHIROPRACTIC, LLC
Other - Org Name:GREEN CHIROPRACTIC AND ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:417-858-8818
Mailing Address - Street 1:1134 W MAPLEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4763
Mailing Address - Country:US
Mailing Address - Phone:417-522-9395
Mailing Address - Fax:
Practice Address - Street 1:8800 W STATE HIGHWAY 86
Practice Address - Street 2:
Practice Address - City:SHELL KNOB
Practice Address - State:MO
Practice Address - Zip Code:65747-9176
Practice Address - Country:US
Practice Address - Phone:417-858-8818
Practice Address - Fax:417-858-8819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO005235111N00000X
MO171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO756208302Medicaid
MO756208302Medicaid