Provider Demographics
NPI:1316238397
Name:GREEN, JUSTIN Z (LAC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:Z
Last Name:GREEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3603
Mailing Address - Country:US
Mailing Address - Phone:406-250-5786
Mailing Address - Fax:406-848-6236
Practice Address - Street 1:44 VILLAGE LOOP RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2793
Practice Address - Country:US
Practice Address - Phone:406-250-5786
Practice Address - Fax:406-848-6236
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-ACU-LIC-175171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist