Provider Demographics
NPI:1356500474
Name:FAMILY CHIROPRACTIC CENTER OF SANFORD, PA
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC CENTER OF SANFORD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:919-775-2114
Mailing Address - Street 1:1100 CARTHAGE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4161
Mailing Address - Country:US
Mailing Address - Phone:919-775-2114
Mailing Address - Fax:919-776-4032
Practice Address - Street 1:1100 CARTHAGE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4161
Practice Address - Country:US
Practice Address - Phone:919-775-2114
Practice Address - Fax:919-776-4032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1618111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty