Provider Demographics
NPI:1528015377
Name:FAMILY CHIROPRACTIC CARE, PC
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:VASSALLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-785-9588
Mailing Address - Street 1:24304 NYS RTE 37
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-5870
Mailing Address - Country:US
Mailing Address - Phone:315-785-9588
Mailing Address - Fax:315-786-3099
Practice Address - Street 1:24304 NYS RTE 37
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-5870
Practice Address - Country:US
Practice Address - Phone:315-785-9588
Practice Address - Fax:315-786-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010578111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty