Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | DC15218 | CA |
NPI | 1013054576 |
---|---|
Provider Name | Dr. Susan Terry Green |
First Address | Pacifica, CA 94044-4127 |
Second Address | San Francisco, CA 94122-1433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T05681 | (02) | CA |