Provider Demographics
NPI:1841354420
Name:FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:360-352-8112
Mailing Address - Street 1:204 PINEHURST DRIVE SW
Mailing Address - Street 2:#103
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501
Mailing Address - Country:US
Mailing Address - Phone:360-352-8112
Mailing Address - Fax:360-352-8113
Practice Address - Street 1:204 PINEHURST DRIVE SW
Practice Address - Street 2:#103
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501
Practice Address - Country:US
Practice Address - Phone:360-352-8112
Practice Address - Fax:360-352-8113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00002441111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU11462Medicare UPIN