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General NPI Number Information
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NPI Number | 1174795108
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Entity Type | Organization
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Legal Business Name | FAMILY CHIROPRACTIC CLINIC, P.C.
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Dates
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Enumeration Date | 03/31/2008
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | 401 S BENT ST STE A
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City | POWELL
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State | WY
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Zip | 82435-2837
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Country | US
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Telephone | 307-754-5777
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Fax | 307-754-5316
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Provider Business Mailing Address
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Address Line | 401 S BENT ST STE A
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City | POWELL
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State | WY
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Zip | 82435-2837
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Country | US
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Telephone | 307-754-5777
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Fax | 307-754-5316
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAHIM KHAN
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Credential | D.C,
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Telephone | 307-754-5777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 606
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License Number State | WY
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