Provider Demographics
NPI:1619135308
Name:FAMILY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:985-429-0005
Mailing Address - Street 1:2790 W CHURCH ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-2860
Mailing Address - Country:US
Mailing Address - Phone:985-429-0005
Mailing Address - Fax:985-429-0018
Practice Address - Street 1:2790 W CHURCH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-2860
Practice Address - Country:US
Practice Address - Phone:985-429-0005
Practice Address - Fax:985-429-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1039111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA484987371AOtherBLUE CROSS
LA484987371AOtherBLUE CROSS
LAU54834Medicare UPIN