1558545350 NPI number — GREEN ACRES FAMILY CHIROPRACTIC AND WELLNESS CENTER ,INC

Table of content: (NPI 1558545350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558545350 NPI number — GREEN ACRES FAMILY CHIROPRACTIC AND WELLNESS CENTER ,INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREEN ACRES FAMILY CHIROPRACTIC AND WELLNESS CENTER ,INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558545350
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6038 LAKE WORTH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENACRES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33463-4287
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-439-8122
Provider Business Mailing Address Fax Number:
561-439-8123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6038 LAKE WORTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENACRES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33463-4287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-439-8122
Provider Business Practice Location Address Fax Number:
561-439-8123
Provider Enumeration Date:
12/28/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RICHARDSON
Authorized Official First Name:
ANDREW J MACANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
661-439-8122

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)