Provider Demographics
NPI:1932650264
Name:GREEN CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:GREEN CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-831-0334
Mailing Address - Street 1:203 HAMRIC DR W
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-2350
Mailing Address - Country:US
Mailing Address - Phone:256-831-0334
Mailing Address - Fax:256-831-0633
Practice Address - Street 1:203 HAMRIC DR W
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-2350
Practice Address - Country:US
Practice Address - Phone:256-831-0334
Practice Address - Fax:256-831-0633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1552261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000045720Medicare PIN