Provider Demographics
NPI:1659596294
Name:FAMILY CARE CHIROPRACTIC
Entity Type:Organization
Organization Name:FAMILY CARE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAO
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-742-0466
Mailing Address - Street 1:1835 N BEALE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-6912
Mailing Address - Country:US
Mailing Address - Phone:530-742-0466
Mailing Address - Fax:530-742-0478
Practice Address - Street 1:1835 N BEALE RD
Practice Address - Street 2:SUITE B
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-6912
Practice Address - Country:US
Practice Address - Phone:530-742-0466
Practice Address - Fax:530-742-0478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0268293Medicaid
CADC0268293Medicaid
CADC0268292Medicare ID - Type Unspecified