Provider Demographics
NPI:1316244155
Name:GREEN, JEREMY WARREN (DC)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:WARREN
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 1:43950 MARGARITA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-2743
Mailing Address - Country:US
Mailing Address - Phone:951-302-0130
Mailing Address - Fax:
Practice Address - Street 1:43950 MARGARITA RD
Practice Address - Street 2:SUITE A
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-2743
Practice Address - Country:US
Practice Address - Phone:951-302-0130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 31877111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor