Organization
PREMIER CHIROPRACTIC DOWNTOWN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ALLEN GREEN D.C. (CHIROPRACTOR)
(502) 561-0490
Entity
Organization
Contact information
Practice address
2137 DIXIE HWY, LOUISVILLE, KY 40210-2242
(502) 561-0490
(502) 409-4964
Mailing address
7716 BARBOUR PLACE DR, LOUISVILLE, KY 40241-2730
(502) 561-0490
(502) 409-4964
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
3776
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000051525
ANTHEM
LA
01
—
2623859000
PASSPORT ADVANTAGE
KY
01
—
50008078
PASSPORT
KY
05
—
85001758
—
KY
Enumeration date
05/21/2007
Last updated
10/30/2012
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