Provider Demographics
NPI:1164078440
Name:GREEN, JODI K (DC)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:K
Last Name:GREEN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 DANVILLE RD SW STE C
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35603-4278
Mailing Address - Country:US
Mailing Address - Phone:256-822-2007
Mailing Address - Fax:
Practice Address - Street 1:2418 DANVILLE RD SW STE C
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4278
Practice Address - Country:US
Practice Address - Phone:256-822-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor