MEDICARE: FAMILY CHIROPRACTIC CENTER OF LOGAN CO. INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	1492	OH

General Provider Information

NPI Number	:	1982818340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CHIROPRACTIC CENTER OF LOGAN CO. INC.

Provider Business Mailing Address
First Line	:	412 E COLUMBUS AVE
Second Line	:
City	:	BELLEFONTAINE
State	:	OH
Zip	:	43311-2004
Country	:	US
Telephone Number	:	937-593-7711
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 E COLUMBUS AVE
Second Line	:
City	:	BELLEFONTAINE
State	:	OH
Zip	:	43311-2004
Country	:	US
Telephone Number	:	937-593-7711
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES THOMAS TASSELL
Credential	:
Telephone Number	:	937-593-7711

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	08/22/2020

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