Provider Demographics
NPI:1548533649
Name:VAN AMBERG FAMILY CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:VAN AMBERG FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAN AMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-245-6294
Mailing Address - Street 1:606 METACOM AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WARREN
Mailing Address - State:RI
Mailing Address - Zip Code:02885-2837
Mailing Address - Country:US
Mailing Address - Phone:401-245-6294
Mailing Address - Fax:
Practice Address - Street 1:606 METACOM AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:WARREN
Practice Address - State:RI
Practice Address - Zip Code:02885-2837
Practice Address - Country:US
Practice Address - Phone:401-245-6294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDC00421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty