Provider Demographics
NPI:1013054576
Name:GREEN, SUSAN TERRY (DC,DACRB)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:TERRY
Last Name:GREEN
Suffix:
Gender:F
Credentials:DC,DACRB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 CORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-5538
Mailing Address - Country:US
Mailing Address - Phone:415-818-3210
Mailing Address - Fax:
Practice Address - Street 1:406 CORTLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-5538
Practice Address - Country:US
Practice Address - Phone:415-818-3210
Practice Address - Fax:415-661-0826
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15218111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0152180Medicare ID - Type Unspecified
CAT05681Medicare UPIN