Provider Demographics
NPI:1255362414
Name:FAMILY CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:FAMILY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:ROLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:530-244-1088
Mailing Address - Street 1:2636A CHURN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1125
Mailing Address - Country:US
Mailing Address - Phone:530-244-1088
Mailing Address - Fax:530-221-4464
Practice Address - Street 1:2636A CHURN CREEK RD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1125
Practice Address - Country:US
Practice Address - Phone:530-244-1088
Practice Address - Fax:530-221-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19587111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ54283ZOtherBLUE SHIELD
CAT89706Medicare UPIN
CAZZZ54283ZOtherBLUE SHIELD