Provider Demographics
NPI:1053594465
Name:FAMILY CHIROPRACTIC WELLNESS CENTER, INC.
Entity type:Organization
Organization Name:FAMILY CHIROPRACTIC WELLNESS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:319-390-2970
Mailing Address - Street 1:3150 E AVE NW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52405-2900
Mailing Address - Country:US
Mailing Address - Phone:319-390-2970
Mailing Address - Fax:319-390-2959
Practice Address - Street 1:3150 E AVE NW
Practice Address - Street 2:SUITE 101
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52405-2900
Practice Address - Country:US
Practice Address - Phone:319-390-2970
Practice Address - Fax:319-390-2959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05500261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center