Provider Demographics
NPI:1003950023
Name:ADVANCE CHIROPRACTIC CLINIC, P.C.
Entity Type:Organization
Organization Name:ADVANCE CHIROPRACTIC CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-772-2670
Mailing Address - Street 1:2840 19TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5957
Mailing Address - Country:US
Mailing Address - Phone:701-772-2670
Mailing Address - Fax:701-772-2706
Practice Address - Street 1:2840 19TH AVE S
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5957
Practice Address - Country:US
Practice Address - Phone:701-772-2670
Practice Address - Fax:701-772-2706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND566111N00000X
ND516111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND013490OtherBC/BS PROVIDER NUMBER
ND10679570758OtherNPI
ND010810OtherBC/BS PROVIDER NUMBER
NDN13490OtherMEDICARE ID-PIN
ND1003814484OtherNPI
ND675-001OtherBC/BS CLINIC NUMBER
NDN10810OtherMEDICARE ID-PIN
ND1003950023OtherGROUP NPI
ND18198Medicaid
ND16663Medicaid
ND013490OtherBC/BS PROVIDER NUMBER