Provider Demographics
NPI:1124238001
Name:FIRST CHIROPRACTIC FAMILY WELLNESS CENTER A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:FIRST CHIROPRACTIC FAMILY WELLNESS CENTER A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:818-249-2300
Mailing Address - Street 1:2235 HONOLULU AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1635
Mailing Address - Country:US
Mailing Address - Phone:818-249-2300
Mailing Address - Fax:
Practice Address - Street 1:2235 HONOLULU AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1635
Practice Address - Country:US
Practice Address - Phone:818-249-2300
Practice Address - Fax:818-249-3204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18540111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty