Provider Demographics
NPI:1093884140
Name:ADVANCE WELLNESS CHIROPRACTIC
Entity Type:Organization
Organization Name:ADVANCE WELLNESS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:DRAPER
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:336-316-0827
Mailing Address - Street 1:604 PASTEUR DR STE B
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27403-1145
Mailing Address - Country:US
Mailing Address - Phone:336-316-0827
Mailing Address - Fax:336-316-0828
Practice Address - Street 1:604 PASTEUR DR STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1145
Practice Address - Country:US
Practice Address - Phone:336-316-0827
Practice Address - Fax:336-316-0828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2903111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU87100Medicare UPIN