Provider Demographics
NPI:1295513133
Name:GREEN, STORMY (DC)
Entity type:Individual
Prefix:DR
First Name:STORMY
Middle Name:
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 1:8101 HACKS CROSS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-4032
Mailing Address - Country:US
Mailing Address - Phone:901-221-7173
Mailing Address - Fax:
Practice Address - Street 1:2690 KIRBY WHITTEN RD STE 109
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4742
Practice Address - Country:US
Practice Address - Phone:901-221-7173
Practice Address - Fax:662-932-8774
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor