Provider Demographics
NPI:1093172868
Name:ADVANCED CHIROPRACTIC & REHAB, INC.
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC & REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-726-7404
Mailing Address - Street 1:PO BOX 3351
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44513-3351
Mailing Address - Country:US
Mailing Address - Phone:330-726-7404
Mailing Address - Fax:333-072-9916
Practice Address - Street 1:755 BOARDMAN CANFIELD RD
Practice Address - Street 2:SUITE P-1
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4300
Practice Address - Country:US
Practice Address - Phone:330-726-7404
Practice Address - Fax:330-729-9166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT005210261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation