Provider Demographics
NPI:1669414314
Name:FAMILY CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:G
Authorized Official - Last Name:HORSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-513-1536
Mailing Address - Street 1:2414 BLUEBALL AVENUE
Mailing Address - Street 2:
Mailing Address - City:BOOTHWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19061-3653
Mailing Address - Country:US
Mailing Address - Phone:302-513-1536
Mailing Address - Fax:
Practice Address - Street 1:2414 BLUEBALL AVENUE
Practice Address - Street 2:
Practice Address - City:BOOTHWYN
Practice Address - State:PA
Practice Address - Zip Code:19061-3653
Practice Address - Country:US
Practice Address - Phone:610-485-3090
Practice Address - Fax:302-477-0564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002675L111N00000X
PADC002394L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FA002611Medicare ID - Type Unspecified
T29181Medicare UPIN
T30077Medicare UPIN