Provider Demographics
NPI:1003670753
Name:ADVANCED CARE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:ADVANCED CARE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-328-9800
Mailing Address - Street 1:16331 SILVER LANDINGS
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9184
Mailing Address - Country:US
Mailing Address - Phone:810-280-4505
Mailing Address - Fax:
Practice Address - Street 1:3160 W SILVER LAKE RD STE B
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-1321
Practice Address - Country:US
Practice Address - Phone:248-328-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED CARE CHIROPRACTIC P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306038732OtherINDIVIDUAL NPI