Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC28669 | CA |
NPI | 1124220793 |
---|---|
Provider Name | Dr. Matthew Stuart Green |
First Address | Oakland, CA 94611-2804 |
Second Address | Oakland, CA 94611-2804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 22/07/2013 |