Provider Demographics
NPI:1043231129
Name:ADVANCED WELLNESS CENTERS INC
Entity Type:Organization
Organization Name:ADVANCED WELLNESS CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:D
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-582-2225
Mailing Address - Street 1:1814 NORTH FEDERAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460
Mailing Address - Country:US
Mailing Address - Phone:561-582-2225
Mailing Address - Fax:561-582-6358
Practice Address - Street 1:1814 NORTH FEDERAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460
Practice Address - Country:US
Practice Address - Phone:561-582-2225
Practice Address - Fax:561-582-6358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6682111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U48871Medicare UPIN
22995Medicare ID - Type Unspecified