Provider Demographics
NPI:1295830610
Name:FAMILY CHIROPRACTIC COMPLEX
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC COMPLEX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:931-685-0040
Mailing Address - Street 1:1509 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2323
Mailing Address - Country:US
Mailing Address - Phone:931-247-1075
Mailing Address - Fax:931-735-6290
Practice Address - Street 1:1509 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2323
Practice Address - Country:US
Practice Address - Phone:931-247-1075
Practice Address - Fax:931-735-6290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN472111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3679711Medicare PIN