Provider Demographics
NPI:1386610681
Name:GREEN, BART NELS (DC, PHD)
Entity type:Individual
Prefix:DR
First Name:BART
Middle Name:NELS
Last Name:GREEN
Suffix:
Gender:M
Credentials:DC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 E VALLEY PKWY
Mailing Address - Street 2:#3-486
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-2322
Mailing Address - Country:US
Mailing Address - Phone:858-208-8779
Mailing Address - Fax:
Practice Address - Street 1:10155 PACIFIC HEIGHTS BLVD
Practice Address - Street 2:BUILDING AZ, 2ND FLOOR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121
Practice Address - Country:US
Practice Address - Phone:858-651-5918
Practice Address - Fax:858-622-1658
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22689111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician