Provider Demographics
NPI:1588032916
Name:FAMILY FOOT AND ANKLE CENTER
Entity Type:Organization
Organization Name:FAMILY FOOT AND ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHICKO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:540-785-7000
Mailing Address - Street 1:1420 CENTRAL PARK BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4932
Mailing Address - Country:US
Mailing Address - Phone:540-785-7000
Mailing Address - Fax:540-785-7005
Practice Address - Street 1:1420 CENTRAL PARK BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4932
Practice Address - Country:US
Practice Address - Phone:540-785-7000
Practice Address - Fax:540-785-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-02
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7558010001OtherMEDICARE NSC