Provider Demographics
NPI:1184927832
Name:FAMILY CHIROPRACTIC CLINIC, INC.
Entity type:Organization
Organization Name:FAMILY CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WELBORN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-486-2991
Mailing Address - Street 1:PO BOX 631
Mailing Address - Street 2:616 1/2 WHITCOMB AVE
Mailing Address - City:TONASKET
Mailing Address - State:WA
Mailing Address - Zip Code:98855-0631
Mailing Address - Country:US
Mailing Address - Phone:509-486-2991
Mailing Address - Fax:509-486-2992
Practice Address - Street 1:616 1/2 WHITCOMB AVE
Practice Address - Street 2:
Practice Address - City:TONASKET
Practice Address - State:WA
Practice Address - Zip Code:98855
Practice Address - Country:US
Practice Address - Phone:509-486-2991
Practice Address - Fax:509-486-2992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00001860111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2021079Medicaid
WA117078OtherDEPARTMENT OF LABOR AND INDUSTRIES
WA117078OtherDEPARTMENT OF LABOR AND INDUSTRIES
WAT61014Medicare UPIN