Ilan Green, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC011631 Issued in PA

Practice address

827 W Lancaster Ave FL 2
Bryn Mawr, PA 19010-3436

Phone

(610) 808-9960

Fax

(610) 808-9960

NPI assigned

Nov 27, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Specialty

Chiropractic

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Momenta Chiropractic LLCGroup PAC ID 9133525686, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Momenta Chiropractic LLC

  • Chiropractor
  • Bryn Mawr, PA
  • NPI 1285203745
  Medicare reassignment Care Compare group NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1598301301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "827 W LANCASTER AVE FL 2",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103436",
            "telephone_number": "610-808-9960",
            "fax_number": "610-808-9960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "827 W LANCASTER AVE FL 2",
            "city": "BRYN MAWR",
            "state": "PA",
            "postal_code": "190103436",
            "telephone_number": "610-808-9960",
            "fax_number": "610-808-9960"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2630 77th Ave SE Ste 102",
            "address_purpose": "LOCATION",
            "city": "Mercer Island",
            "state": "WA",
            "postal_code": "980403085",
            "country_code": "US",
            "telephone_number": "206-922-2237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "ILAN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-27",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WA",
            "license": "CH61013340",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC011631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Graham, LSW
• Jeffrey Granett, MD
• Anne W Grant, CRNP
• Green Healthcare Associates, Inc.
• Emily Rose Green, MSN, CNM, WHNP-BC
• Sean Dennis Green Sr., M.D.
• Sandra Greenberg, ED.D., LCSW, BCD
• Scott R Greenberg, MD
• Greene House Counseling,LLC
• Angela Greene, LCSW

• Chiropractor in Bryn Mawr, PA
• Providers in Bryn Mawr, PA by specialty
• Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.