Provider Demographics
NPI:1104082502
Name:FAMILYFIRST CHIROPRACTIC, PC
Entity type:Organization
Organization Name:FAMILYFIRST CHIROPRACTIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-831-8877
Mailing Address - Street 1:3533 DUNN RD
Mailing Address - Street 2:SUITE 236
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6761
Mailing Address - Country:US
Mailing Address - Phone:314-831-8877
Mailing Address - Fax:
Practice Address - Street 1:3533 DUNN RD
Practice Address - Street 2:SUITE 236
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6761
Practice Address - Country:US
Practice Address - Phone:314-831-8877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000014830Medicare PIN