Provider Demographics
NPI:1861673535
Name:FAMILY CARE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:FAMILY CARE CHIROPRACTIC PC
Other - Org Name:FAMILY CARE CHIROPRACTIC PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:PRICE KLOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-388-6364
Mailing Address - Street 1:516 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-5821
Mailing Address - Country:US
Mailing Address - Phone:563-388-6364
Mailing Address - Fax:563-388-6364
Practice Address - Street 1:516 W 35TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5821
Practice Address - Country:US
Practice Address - Phone:563-388-6364
Practice Address - Fax:563-388-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty