Healthcare Provider Details

I. General information

NPI: 1932153327
Provider Name (Legal Business Name): BRIAN ROBERT GREEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

783 PINE VALLEY DR
PITTSBURGH PA
15239-2842
US

IV. Provider business mailing address

783 PINE VALLEY DR
PITTSBURGH PA
15239-2842
US

V. Phone/Fax

Practice location:
  • Phone: 724-733-2225
  • Fax: 724-733-2500
Mailing address:
  • Phone: 724-733-2225
  • Fax: 724-733-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC006907L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: