Provider Demographics
NPI:1023208055
Name:ADVANCED CHIROPRACTIC SPECIALIST CENTER, P.A.
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC SPECIALIST CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OMID
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLTANI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:2813-160-0707
Mailing Address - Street 1:350 N TEXAS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4960
Mailing Address - Country:US
Mailing Address - Phone:281-316-0707
Mailing Address - Fax:281-338-4078
Practice Address - Street 1:350 N TEXAS AVE STE B
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4960
Practice Address - Country:US
Practice Address - Phone:281-316-0707
Practice Address - Fax:281-338-4078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9404111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C8588Medicaid