Provider Demographics
NPI:1841387784
Name:GREEN, AKIBA JOSEPH (DNM)
Entity type:Individual
Prefix:DR
First Name:AKIBA
Middle Name:JOSEPH
Last Name:GREEN
Suffix:
Gender:M
Credentials:DNM
Other - Prefix:DR
Other - First Name:AKIBA
Other - Middle Name:JOSEPH
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:21000 TORRENCE CHAPEL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-6874
Mailing Address - Country:US
Mailing Address - Phone:704-987-3993
Mailing Address - Fax:704-987-3991
Practice Address - Street 1:21000 TORRENCE CHAPEL RD STE 101
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6874
Practice Address - Country:US
Practice Address - Phone:704-987-3993
Practice Address - Fax:704-987-3991
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3241111N00000X
ZZ2117-2065175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5903436Medicaid
NC5903436Medicaid
NC2341240Medicare ID - Type UnspecifiedGROUP NUMBER
NC2457060AMedicare ID - Type UnspecifiedINDIVIDUAL ID#