Provider Demographics
NPI:1861669335
Name:FAMILY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:858-578-0058
Mailing Address - Street 1:12285 SCRIPPS POWAY PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-6149
Mailing Address - Country:US
Mailing Address - Phone:858-578-0058
Mailing Address - Fax:
Practice Address - Street 1:12285 SCRIPPS POWAY PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-6149
Practice Address - Country:US
Practice Address - Phone:858-578-0058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22140111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty