Healthcare Provider Details

I. General information

NPI: 1760481063
Provider Name (Legal Business Name): ADLAI STEVEN GREEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 N PARK AVE
APOPKA FL
32712-4152
US

IV. Provider business mailing address

424 N PARK AVE
APOPKA FL
32712-4152
US

V. Phone/Fax

Practice location:
  • Phone: 407-886-0611
  • Fax: 407-886-2817
Mailing address:
  • Phone: 407-886-0611
  • Fax: 407-886-2817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH2710
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: