Provider Demographics
NPI:1073761532
Name:ADVANCED ALTERNATIVE SPINAL CARE
Entity Type:Organization
Organization Name:ADVANCED ALTERNATIVE SPINAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:EGSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:903-583-7411
Mailing Address - Street 1:417 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-4322
Mailing Address - Country:US
Mailing Address - Phone:903-583-7411
Mailing Address - Fax:903-583-9601
Practice Address - Street 1:417 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4322
Practice Address - Country:US
Practice Address - Phone:903-583-7411
Practice Address - Fax:903-583-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty