MEDICARE: DR. LISA ANN GREEN D.C.

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	CH0006683	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558349654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA ANN GREEN D.C.

Provider Business Mailing Address
First Line	:	11350 NW 1ST CT
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-8174
Country	:	US
Telephone Number	:	954-270-5610
Fax Number	:	954-775-3931

Provider Business Practice Location Address
First Line	:	1304 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6623
Country	:	US
Telephone Number	:	954-977-0888
Fax Number	:	954-804-0933

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	01/23/2015

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