Provider Demographics
NPI:1740243310
Name:GREENACRES CHIROPRACTIC GROUP
Entity Type:Organization
Organization Name:GREENACRES CHIROPRACTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELBY HODISH
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER/PARTNER
Authorized Official - Phone:561-964-9331
Mailing Address - Street 1:7362 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2529
Mailing Address - Country:US
Mailing Address - Phone:561-964-9331
Mailing Address - Fax:561-966-5098
Practice Address - Street 1:7362 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2529
Practice Address - Country:US
Practice Address - Phone:561-964-9331
Practice Address - Fax:561-966-5098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45875OtherBC/BS OF FLORIDA GROUP ID