Provider Demographics
NPI:1124187711
Name:FAMILY CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC CENTER LLC
Other - Org Name:GATEWAY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GILBER
Authorized Official - Middle Name:O
Authorized Official - Last Name:LAFRANCE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:508-295-1173
Mailing Address - Street 1:1 RECOVERY ROAD
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571
Mailing Address - Country:US
Mailing Address - Phone:508-295-1173
Mailing Address - Fax:508-295-1351
Practice Address - Street 1:1 RECOVERY ROAD
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571
Practice Address - Country:US
Practice Address - Phone:508-295-1173
Practice Address - Fax:508-295-1351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U38433Medicare UPIN