Provider Demographics
NPI:1013389469
Name:ADVANCED CARE CHIROPRACTIC AND REHAB
Entity Type:Organization
Organization Name:ADVANCED CARE CHIROPRACTIC AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:FIELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:423-929-2225
Mailing Address - Street 1:3043 BOONES CREEK RD STE 107
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4959
Mailing Address - Country:US
Mailing Address - Phone:423-929-2225
Mailing Address - Fax:888-639-0839
Practice Address - Street 1:3043 BOONES CREEK RD STE 107
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-4959
Practice Address - Country:US
Practice Address - Phone:423-929-2225
Practice Address - Fax:888-639-0839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000001283111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3032514OtherBLUE CROSS BLUE SHIELD OF TENNESSEE
3678271Medicare PIN