Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | 09312 | TX |
N | 111NI0013X | Independent Medical Examiner | 09312 | TX |
N | 111NR0400X | Rehabilitation Chiropractor | 09312 | TX |
Y | 111NX0100X | Occupational Health | 09312 | TX |
NPI | 1639534274 |
---|---|
Provider Name | Dr. Andrew Green |
First Address | The Woodlands, TX 77384-4681 |
Second Address | Houston, TX 77074-2929 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2015 |
Last Update Date | 28/12/2015 |