Provider Demographics
NPI:1073798278
Name:FAMILY CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-525-0400
Mailing Address - Street 1:1920 W 5200 S STE 5
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-3471
Mailing Address - Country:US
Mailing Address - Phone:801-525-0400
Mailing Address - Fax:801-525-1105
Practice Address - Street 1:1920 W. 5200 S. #5
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-3452
Practice Address - Country:US
Practice Address - Phone:801-525-0400
Practice Address - Fax:801-525-1105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT370533-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty