Healthcare Provider Details

I. General information

NPI: 1952559155
Provider Name (Legal Business Name): MARTIN B. GREEN, D.C., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 NE 124TH ST
NORTH MIAMI FL
33161-5523
US

IV. Provider business mailing address

640 NE 124TH ST
NORTH MIAMI FL
33161-5523
US

V. Phone/Fax

Practice location:
  • Phone: 305-891-4114
  • Fax: 305-891-4114
Mailing address:
  • Phone: 305-891-4114
  • Fax: 305-891-4114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: MARTIN B. GREEN
Title or Position: MANAGING MEMBER
Credential: D.C.
Phone: 305-891-4114