Provider Demographics
NPI:1881711042
Name:FAMILY CARE CHIROPRACTIC CLINIC, P.C.
Entity type:Organization
Organization Name:FAMILY CARE CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:972-771-9448
Mailing Address - Street 1:316 S GOLIAD ST STE 111
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-3761
Mailing Address - Country:US
Mailing Address - Phone:972-771-9448
Mailing Address - Fax:972-771-8393
Practice Address - Street 1:316 S GOLIAD ST STE 111
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-3761
Practice Address - Country:US
Practice Address - Phone:972-771-9448
Practice Address - Fax:972-771-8393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX601783Medicare ID - Type Unspecified