Individual
DR. JOHN ROGER GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
212 1/2 NW 1ST ST, GALVA, IL 61434-1380
(309) 932-8505
(309) 932-8505
Mailing address
212 1/2 NW 1ST ST, P O BOX 46, GALVA, IL 61434-1380
(309) 932-8505
(309) 932-8505
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
038-009663
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3732006
BLUE CROSS PROVIDER NO.
IL
Enumeration date
09/26/2006
Last updated
07/08/2007
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