Provider Demographics
NPI:1760481063
Name:GREEN, ADLAI STEVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:ADLAI
Middle Name:STEVEN
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 1:424 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-4152
Mailing Address - Country:US
Mailing Address - Phone:407-886-0611
Mailing Address - Fax:407-886-2817
Practice Address - Street 1:424 N PARK AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-4152
Practice Address - Country:US
Practice Address - Phone:407-886-0611
Practice Address - Fax:407-886-2817
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL380410100Medicaid
FL380410100Medicaid
FL88398Medicare ID - Type Unspecified