Provider Demographics
NPI:1881692127
Name:GREEN, ADAM WAYNE (DC)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:WAYNE
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 1:2710 BROADWAY EXTENSION
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-6856
Mailing Address - Country:US
Mailing Address - Phone:304-485-0106
Mailing Address - Fax:304-485-5671
Practice Address - Street 1:2710 BROADWAY EXTENSION
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-6856
Practice Address - Country:US
Practice Address - Phone:304-485-0106
Practice Address - Fax:304-485-5671
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV565111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0131852000Medicaid
550712981002OtherBCBS
WV155071298100OtherWORKERS COMP.
U37278Medicare UPIN
0729071Medicare ID - Type Unspecified