Mitchell Wayne Green, D.C.
Individual provider Active NPI Chiropractor · Munster, IN
NPI 1174959977 · NPPES record last updated Sep 25, 2013
Key facts
- NPI
- 1174959977
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Chiropractor 111N00000X
- License
- 08002727A (IN)
- Practice address
- 706 Ridge Rd
Munster, IN 46321-1612 - Phone
- (219) 836-8890
- NPI assigned
- Sep 25, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Chiropractic
- Education
- Palmer College Chiropractic - Davenport, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Carlson Chiropractic Corporation
Practice addresses (Care Compare)
2130 2ND St
White Bear Lake, MN 55110-3207
Phone (651) 762-8040
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160531000122 | MN | Practitioner - Chiropractic | 4486881273 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007695 | IA | MD | Chiropractor |
| 038012402 | IL | MD | Chiropractor |
| 6123 | MN | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carlson Chiropractic Corporation | Chiropractor | Current |
Accepting new patients |
Locations
4717 Clark Ave
White Bear Lk, MN 55110
Phone (651) 762-8040
2130 2nd St
White Bear Lk, MN 55110
Phone (651) 762-8040
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor | 111N00000X | 08002727A | IN | Yes |
| Chiropractor | 111N00000X | 038012402 | IL | |
| Chiropractor | 111N00000X | 007695 | IA |
Addresses
Primary practice location
706 Ridge Rd
Munster, IN 46321-1612
Mailing address
706 Ridge Rd
Munster, IN 46321-1612
Phone (219) 836-8890
Other providers in Munster, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 25, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.