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General NPI Number Information
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NPI Number | 1669880142
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Entity Type | Organization
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Legal Business Name | FAMILY SOURCE CHIROPRACTIC LLC
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Dates
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Enumeration Date | 07/28/2014
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Last Update Date | 07/28/2014
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Provider Practice Location Address
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Address Line | 167 S STATE ST STE 190
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City | WESTERVILLE
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State | OH
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Zip | 43081-2282
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Country | US
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Telephone | 740-334-5886
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Fax |
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Provider Business Mailing Address
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Address Line | 167 S STATE ST STE 190
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City | WESTERVILLE
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State | OH
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Zip | 43081-2282
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WHITNEY AMOS-MCNARY
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Credential | DC
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Telephone | 740-334-5886
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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 | 4388
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License Number State | OH
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