Provider Demographics
NPI:1346338977
Name:GREEN, STEVEN BERT (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BERT
Last Name:GREEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7751
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-7751
Mailing Address - Country:US
Mailing Address - Phone:256-831-0334
Mailing Address - Fax:256-831-0633
Practice Address - Street 1:203 HAMRIC DR W
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-2350
Practice Address - Country:US
Practice Address - Phone:256-831-0334
Practice Address - Fax:256-831-0633
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51045720GREOtherBLUECROSS/BLUESHIELD AL
AL51045720GREOtherBLUECROSS/BLUESHIELD AL
ALU49564Medicare UPIN