Provider Demographics
NPI:1003077470
Name:ADVANCED CHIROPRACTIC HEALTH CENTER PC
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:DAGOSTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-598-9120
Mailing Address - Street 1:27322 23 MILE RD
Mailing Address - Street 2:STE 3
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-2032
Mailing Address - Country:US
Mailing Address - Phone:586-598-9120
Mailing Address - Fax:
Practice Address - Street 1:27322 23 MILE RD
Practice Address - Street 2:STE 3
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-2032
Practice Address - Country:US
Practice Address - Phone:586-598-9120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFD007881111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty