Provider Demographics
NPI:1477602894
Name:YOUR FAMILY CHIROPRACTOR CO.
Entity Type:Organization
Organization Name:YOUR FAMILY CHIROPRACTOR CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAIG
Authorized Official - Middle Name:MALCOM
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-722-5846
Mailing Address - Street 1:1010 E NEW HAVEN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-5603
Mailing Address - Country:US
Mailing Address - Phone:321-722-5846
Mailing Address - Fax:321-722-5848
Practice Address - Street 1:1010 E NEW HAVEN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-5603
Practice Address - Country:US
Practice Address - Phone:321-722-5846
Practice Address - Fax:321-722-5848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9006111N00000X
NYX0110251111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty