Provider Demographics
NPI:1871643171
Name:GREEN, MITCHELL BRUCE (DC)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:BRUCE
Last Name:GREEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:42 BROADWAY
Mailing Address - Street 2:1530
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1617
Mailing Address - Country:US
Mailing Address - Phone:212-269-0300
Mailing Address - Fax:212-269-4060
Practice Address - Street 1:42 BROADWAY
Practice Address - Street 2:SUITE 1530
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1617
Practice Address - Country:US
Practice Address - Phone:212-269-0300
Practice Address - Fax:212-269-4060
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2787111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor