Provider Demographics
NPI:1487057592
Name:GREEN, VANESSA (DC)
Entity type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10208 S 168TH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-4185
Mailing Address - Country:US
Mailing Address - Phone:402-884-7799
Mailing Address - Fax:
Practice Address - Street 1:10208 S 168TH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136-4185
Practice Address - Country:US
Practice Address - Phone:620-330-6602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-02
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1799111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor