Healthcare Provider Details

I. General information

NPI: 1013054576
Provider Name (Legal Business Name): SUSAN TERRY GREEN DC,DACRB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 CORTLAND AVE
SAN FRANCISCO CA
94110-5538
US

IV. Provider business mailing address

406 CORTLAND AVE
SAN FRANCISCO CA
94110-5538
US

V. Phone/Fax

Practice location:
  • Phone: 415-818-3210
  • Fax: 415-661-0826
Mailing address:
  • Phone: 415-818-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC15218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: