MEDICARE: GREENACRES CHIROPRACTIC GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45875	OTHER	FL	BC/BS OF FLORIDA GROUP ID

General Provider Information

NPI Number	:	1740243310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENACRES CHIROPRACTIC GROUP

Provider Business Mailing Address
First Line	:	7362 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2529
Country	:	US
Telephone Number	:	561-964-9331
Fax Number	:	561-966-5098

Provider Business Practice Location Address
First Line	:	7362 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2529
Country	:	US
Telephone Number	:	561-964-9331
Fax Number	:	561-966-5098

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	DR. KAREN SHELBY HODISH
Credential	:	OWNER/PARTNER
Telephone Number	:	561-964-9331

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	08/22/2020

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