Provider Demographics
NPI:1952743528
Name:GREENE, JESSICA MICHELLE (ND, DC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MICHELLE
Last Name:GREENE
Suffix:
Gender:F
Credentials:ND, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8889 CAMINITO PLAZA CENTRO UNIT 7308
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-1081
Mailing Address - Country:US
Mailing Address - Phone:408-598-9959
Mailing Address - Fax:
Practice Address - Street 1:928 FORT STOCKTON DR STE 213
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1890
Practice Address - Country:US
Practice Address - Phone:858-255-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32688111NP0017X
CA938175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No111NP0017XChiropractic ProvidersChiropractorPediatric ChiropractorGroup - Multi-Specialty