Provider Demographics
NPI:1891449807
Name:PACIFIC FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:PACIFIC FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:DETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-643-9191
Mailing Address - Street 1:123 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-6007
Mailing Address - Country:US
Mailing Address - Phone:760-643-9191
Mailing Address - Fax:760-643-9299
Practice Address - Street 1:123 MAIN ST
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6007
Practice Address - Country:US
Practice Address - Phone:760-643-9191
Practice Address - Fax:760-643-9299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty