MEDICARE: DR. MITCHELL BRUCE GREEN D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2787	NY

General Provider Information

NPI Number	:	1871643171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL BRUCE GREEN D.C.

Provider Business Mailing Address
First Line	:	42 BROADWAY
Second Line	:	1530
City	:	NEW YORK
State	:	NY
Zip	:	10004-1617
Country	:	US
Telephone Number	:	212-269-0300
Fax Number	:	212-269-4060

Provider Business Practice Location Address
First Line	:	42 BROADWAY
Second Line	:	SUITE 1530
City	:	NEW YORK
State	:	NY
Zip	:	10004-1617
Country	:	US
Telephone Number	:	212-269-0300
Fax Number	:	212-269-4060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	09/22/2008

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