Provider Demographics
NPI:1043491178
Name:ADVANCED HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED HEALTH CENTER, LLC
Other - Org Name:MOLALLA SPINE & SPORT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:VISSERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-263-3033
Mailing Address - Street 1:130 SW 2ND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-4156
Mailing Address - Country:US
Mailing Address - Phone:503-263-3033
Mailing Address - Fax:503-263-3023
Practice Address - Street 1:130 SW 2ND AVE STE 101
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-4156
Practice Address - Country:US
Practice Address - Phone:503-263-3033
Practice Address - Fax:503-263-3023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR273072111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty