Provider Demographics
NPI:1134284110
Name:FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:HELENE
Authorized Official - Last Name:MANASSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:805-642-8788
Mailing Address - Street 1:1445 DONLON STREET
Mailing Address - Street 2:UNIT 15
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-642-8788
Mailing Address - Fax:805-642-8788
Practice Address - Street 1:1445 DONLON ST
Practice Address - Street 2:UNIT 15
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5639
Practice Address - Country:US
Practice Address - Phone:805-642-8788
Practice Address - Fax:805-642-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC12217111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty