Provider Demographics
NPI:1043541535
Name:ADVANCED CHIROPRACTIC CARE CORP.
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC CARE CORP.
Other - Org Name:CHIROPRACTIC HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:R
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:479-434-6672
Mailing Address - Street 1:3017 S 70TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5049
Mailing Address - Country:US
Mailing Address - Phone:479-434-6672
Mailing Address - Fax:479-434-6679
Practice Address - Street 1:3017 S 70TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5049
Practice Address - Country:US
Practice Address - Phone:479-434-6672
Practice Address - Fax:479-434-6679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E4341OtherAHIN SUBMITTER
E4341OtherAHIN SUBMITTER