Individual
MICHAEL GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
5101 BEL AIR ST, BOISE, ID 83705-2774
(208) 386-9525
Mailing address
5101 BEL AIR ST, BOISE, ID 83705-2774
(208) 386-9525
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-384
ID
Other
Enumeration date
07/09/2010
Last updated
07/09/2010
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