Provider Demographics
NPI:1063146090
Name:FAMILY CHIROPRACTIC CARE CENTER, INC
Entity type:Organization
Organization Name:FAMILY CHIROPRACTIC CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-228-0000
Mailing Address - Street 1:1905 LATHAM AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1637
Mailing Address - Country:US
Mailing Address - Phone:419-228-0000
Mailing Address - Fax:419-227-1941
Practice Address - Street 1:306 REICHELDERFER RD
Practice Address - Street 2:
Practice Address - City:CRIDERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45806-2252
Practice Address - Country:US
Practice Address - Phone:419-228-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY CHIROPRACTIC CARE CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-07-14
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty