Provider Demographics
NPI:1770568552
Name:GREEN, JOEL G (DC)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:G
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 1:310 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5442
Mailing Address - Country:US
Mailing Address - Phone:978-744-1123
Mailing Address - Fax:978-744-9683
Practice Address - Street 1:310 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5442
Practice Address - Country:US
Practice Address - Phone:978-744-1123
Practice Address - Fax:978-744-9683
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA489111N00000X
FL2901111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1603531Medicaid
MA1603531Medicaid
T58104Medicare UPIN