Healthcare Provider Details

I. General information

NPI: 1720901929
Provider Name (Legal Business Name): ALEC GREEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 S BECK RD STE 103
POST FALLS ID
83854-4889
US

IV. Provider business mailing address

PO BOX 1482
HAYDEN ID
83835-1482
US

V. Phone/Fax

Practice location:
  • Phone: 208-430-9178
  • Fax:
Mailing address:
  • Phone: 208-430-9178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3571549
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: