Provider Demographics
NPI:1700419751
Name:FAMILY WELLNESS CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:FAMILY WELLNESS CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-397-8999
Mailing Address - Street 1:8 MORGAN LN
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4069
Mailing Address - Country:US
Mailing Address - Phone:716-397-8999
Mailing Address - Fax:
Practice Address - Street 1:8 MORGAN LN
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-4069
Practice Address - Country:US
Practice Address - Phone:716-397-8999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECR2602OtherLICENSE