Provider Demographics
NPI:1255395661
Name:GREEN, TERESA A (DC)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:A
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:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:GUM SPRING
Mailing Address - State:VA
Mailing Address - Zip Code:23065-0293
Mailing Address - Country:US
Mailing Address - Phone:804-477-3194
Mailing Address - Fax:804-477-3324
Practice Address - Street 1:5700 OLD RICHMOND AVE STE A4
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1828
Practice Address - Country:US
Practice Address - Phone:804-477-3194
Practice Address - Fax:804-477-3324
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor