Provider Demographics
NPI:1407049893
Name:FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLZENIUS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-584-7900
Mailing Address - Street 1:611 HIGHWAY 50 W
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-1939
Mailing Address - Country:US
Mailing Address - Phone:636-584-7900
Mailing Address - Fax:636-583-8897
Practice Address - Street 1:611 HIGHWAY 50 W
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1939
Practice Address - Country:US
Practice Address - Phone:636-584-7900
Practice Address - Fax:636-583-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001007358111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU89919Medicare UPIN