Provider Demographics
NPI:1568858751
Name:GREEN, ALEXANDER J (DC)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:J
Last Name:GREEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7712 S VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-2967
Mailing Address - Country:US
Mailing Address - Phone:571-225-8989
Mailing Address - Fax:703-425-5558
Practice Address - Street 1:8993 COTSWOLD DR
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1666
Practice Address - Country:US
Practice Address - Phone:703-425-5550
Practice Address - Fax:703-425-5558
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557221111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor