Provider Demographics
NPI:1558545350
Name:GREEN ACRES FAMILY CHIROPRACTIC AND WELLNESS CENTER ,INC
Entity Type:Organization
Organization Name:GREEN ACRES FAMILY CHIROPRACTIC AND WELLNESS CENTER ,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW J MACANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-439-8122
Mailing Address - Street 1:6038 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4287
Mailing Address - Country:US
Mailing Address - Phone:561-439-8122
Mailing Address - Fax:561-439-8123
Practice Address - Street 1:6038 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-4287
Practice Address - Country:US
Practice Address - Phone:561-439-8122
Practice Address - Fax:561-439-8123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty