Provider Demographics
NPI:1134219041
Name:GREEN, RICHARD LAWRENCE (DC)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LAWRENCE
Last Name:GREEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 COLUMBUS AVE
Mailing Address - Street 2:UNIT 502
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5284
Mailing Address - Country:US
Mailing Address - Phone:617-877-7754
Mailing Address - Fax:
Practice Address - Street 1:4 AVERY ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1005
Practice Address - Country:US
Practice Address - Phone:617-375-8644
Practice Address - Fax:617-375-8581
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA966111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor