MEDICARE: JENNIFER ANNE HOUSE-BRODZIAK ACUPUNCTURIST

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	AP 1878	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C0986	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1952422438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANNE HOUSE-BRODZIAK ACUPUNCTURIST

Provider Business Mailing Address
First Line	:	504 NW 6TH WAY
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-2967
Country	:	US
Telephone Number	:	561-740-7569
Fax Number	:	561-740-7569

Provider Business Practice Location Address
First Line	:	3836 W HILLSBORO BLVD
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-9413
Country	:	US
Telephone Number	:	954-428-4747
Fax Number	:

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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