Provider Demographics
NPI:1003094509
Name:ADVANCED HEALTH CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:ADVANCED HEALTH CHIROPRACTIC, INC.
Other - Org Name:MILLENNIUM CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TYREN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BRATVOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:253-840-3232
Mailing Address - Street 1:702 SOUTH HILL PARK DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-1426
Mailing Address - Country:US
Mailing Address - Phone:253-840-3232
Mailing Address - Fax:
Practice Address - Street 1:702 SOUTH HILL PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1426
Practice Address - Country:US
Practice Address - Phone:253-840-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003571261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2026490Medicaid
WA2026490Medicaid
WAAB36663Medicare PIN