Individual
DR. MARK ALLEN GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
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
08001343
IN
111N00000X
Chiropractor
Primary
3776
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000051525
ANTHEM #
KY
01
—
2623859000
PASSPORT ADVANTAGE ID#
KY
01
—
50008078
PASSPORT PROVIDER #
KY
05
—
85001758
—
KY
Enumeration date
09/28/2006
Last updated
10/30/2012
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