Provider Demographics
NPI:1689058554
Name:FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:NIELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:336-838-8842
Mailing Address - Street 1:1240 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28697-2625
Mailing Address - Country:US
Mailing Address - Phone:336-838-8842
Mailing Address - Fax:844-905-0845
Practice Address - Street 1:1240 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2625
Practice Address - Country:US
Practice Address - Phone:336-838-8842
Practice Address - Fax:336-838-5387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3209111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty