Provider Demographics
NPI:1093984130
Name:ADVANCED CARE PC
Entity Type:Organization
Organization Name:ADVANCED CARE PC
Other - Org Name:ADVANCED CARE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VROOM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-358-1417
Mailing Address - Street 1:837 E POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7617
Mailing Address - Country:US
Mailing Address - Phone:503-669-9495
Mailing Address - Fax:503-669-8257
Practice Address - Street 1:837 E POWELL BLVD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7617
Practice Address - Country:US
Practice Address - Phone:503-669-9495
Practice Address - Fax:503-669-8257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR27-2936111N00000X
OR71 3666111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty