Provider Demographics
NPI:1093031213
Name:GREEN, STEVEN M (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
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 1:8993A COTSWOLD DR
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1601
Mailing Address - Country:US
Mailing Address - Phone:703-425-5550
Mailing Address - Fax:703-425-5558
Practice Address - Street 1:8993A COTSWOLD DR
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1601
Practice Address - Country:US
Practice Address - Phone:703-425-5550
Practice Address - Fax:703-425-5558
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000498111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor