Provider Demographics
NPI:1124209309
Name:FAMILY CHIROPRACTIC CENTER, PA
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:207-783-0078
Mailing Address - Street 1:1485 LISBON ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-3522
Mailing Address - Country:US
Mailing Address - Phone:207-783-0078
Mailing Address - Fax:207-783-2809
Practice Address - Street 1:1485 LISBON ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-3522
Practice Address - Country:US
Practice Address - Phone:207-783-0078
Practice Address - Fax:207-783-2809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR1043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM9822Medicare PIN