Provider Demographics
NPI:1366630725
Name:FAMILY CHIROPRACTIC PRACTICES, P.C.
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC PRACTICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:618-656-6565
Mailing Address - Street 1:239 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-1921
Mailing Address - Country:US
Mailing Address - Phone:618-656-6565
Mailing Address - Fax:618-656-6947
Practice Address - Street 1:239 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-1921
Practice Address - Country:US
Practice Address - Phone:618-656-6565
Practice Address - Fax:618-656-6947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-004680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK18311Medicare PIN