Provider Demographics
NPI:1902477722
Name:FORTIFY FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:FORTIFY FAMILY CHIROPRACTIC, LLC
Other - Org Name:NEWEDGE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DANE
Authorized Official - Last Name:RINER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:509-558-8090
Mailing Address - Street 1:7403 W ARROWHEAD AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1122
Mailing Address - Country:US
Mailing Address - Phone:509-989-5844
Mailing Address - Fax:
Practice Address - Street 1:4525 ROAD 68 STE H
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-9595
Practice Address - Country:US
Practice Address - Phone:509-737-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-02
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty