Provider Demographics
NPI:1982790135
Name:GREEN, MICHELE RENEE (CHIROPRACTOR)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:RENEE
Last Name:GREEN
Suffix:
Gender:F
Credentials:CHIROPRACTOR
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:RENEE
Other - Last Name:SVOBODA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CHIROPRACTOR
Mailing Address - Street 1:2910 QUAIL HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-4989
Mailing Address - Country:US
Mailing Address - Phone:319-415-7612
Mailing Address - Fax:
Practice Address - Street 1:1001 HUDSON ROAD
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-7410
Practice Address - Country:US
Practice Address - Phone:319-277-5616
Practice Address - Fax:319-277-0355
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0763201Medicaid
IA0763201Medicaid
IAI19049Medicare PIN