MEDICARE: SHELLY GREENE LAC.

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	171100000X	Acupuncturist	853	CO

General Provider Information

NPI Number	:	1225329220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY GREENE LAC.

Provider Business Mailing Address
First Line	:	5265 N ACADEMY BLVD
Second Line	:	SUITE 1400
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4060
Country	:	US
Telephone Number	:	719-291-4006
Fax Number	:

Provider Business Practice Location Address
First Line	:	5265 N ACADEMY BLVD
Second Line	:	SUITE 1400
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-4060
Country	:	US
Telephone Number	:	719-291-4006
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2011
Last Update Date	:	12/06/2021

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Directions to “ SHELLY GREENE LAC.” Practice Location

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