Provider Demographics
NPI:1982818340
Name:FAMILY CHIROPRACTIC CENTER OF LOGAN CO. INC.
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC CENTER OF LOGAN CO. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:TASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-593-7711
Mailing Address - Street 1:412 E COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2004
Mailing Address - Country:US
Mailing Address - Phone:937-593-7711
Mailing Address - Fax:
Practice Address - Street 1:412 E COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2004
Practice Address - Country:US
Practice Address - Phone:937-593-7711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1492111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX ID