Provider Demographics
NPI:1235385642
Name:FAMILY CARE CHIROPRACTIC
Entity Type:Organization
Organization Name:FAMILY CARE CHIROPRACTIC
Other - Org Name:CHRISTINE RENEE KIDWELL-MINX
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:KIDWELL-MINX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:810-603-1497
Mailing Address - Street 1:8200 S SAGINAW ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-1843
Mailing Address - Country:US
Mailing Address - Phone:810-603-1497
Mailing Address - Fax:810-603-1498
Practice Address - Street 1:8200 S SAGINAW ST
Practice Address - Street 2:SUITE 600
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-1843
Practice Address - Country:US
Practice Address - Phone:810-603-1497
Practice Address - Fax:810-603-1498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009399111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P57680Medicare PIN