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General NPI Number Information
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NPI Number | 1629218946
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Entity Type | Organization
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Legal Business Name | GREEN CHIROPRACTIC CLINIC
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Dates
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Enumeration Date | 02/26/2009
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 100A S EL CAMINO REAL
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City | SAN MATEO
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State | CA
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Zip | 94401-3810
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Country | US
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Telephone | 415-595-5936
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Fax |
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Provider Business Mailing Address
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Address Line | 806 GARFIELD ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94132-2625
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Country | US
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Telephone | 415-595-5936
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | DR. JACOB GEORGE SAHOURIEH
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Credential | D.C.
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Telephone | 415-595-5936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 31172
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License Number State | CA
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