Provider Demographics
NPI:1013216654
Name:4TH T PLLC
Entity Type:Organization
Organization Name:4TH T PLLC
Other - Org Name:ADVANCE CARE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TORRY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:SLAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-445-2273
Mailing Address - Street 1:3904 LILLIE AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52806-4422
Mailing Address - Country:US
Mailing Address - Phone:563-445-2273
Mailing Address - Fax:563-445-2273
Practice Address - Street 1:3904 LILLIE AVE
Practice Address - Street 2:STE 1
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-4422
Practice Address - Country:US
Practice Address - Phone:563-445-2273
Practice Address - Fax:563-445-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06505111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty