Provider Demographics
NPI:1174821458
Name:FAMILY CHIROPRACTIC AND WELLNESS, LLC
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:BECKNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-373-3376
Mailing Address - Street 1:1405 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5717
Mailing Address - Country:US
Mailing Address - Phone:812-373-3376
Mailing Address - Fax:812-373-7977
Practice Address - Street 1:1405 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5717
Practice Address - Country:US
Practice Address - Phone:812-373-3376
Practice Address - Fax:812-373-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002557A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty