Provider Demographics
NPI:1053861567
Name:ADVANTAGE MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:ADVANTAGE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOPES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-723-0517
Mailing Address - Street 1:770 S 200 E
Mailing Address - Street 2:STE 102
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302
Mailing Address - Country:US
Mailing Address - Phone:435-723-0517
Mailing Address - Fax:435-723-0587
Practice Address - Street 1:770 S 200 E
Practice Address - Street 2:STE 102
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302
Practice Address - Country:US
Practice Address - Phone:435-723-0517
Practice Address - Fax:435-723-0587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5118842-0160111N00000X
207Q00000X
UT189510-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty