Provider Demographics
NPI:1184816522
Name:ADVANCED SPINE & HEALTH CENTER
Entity Type:Organization
Organization Name:ADVANCED SPINE & HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:JAYSON
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:435-752-5522
Mailing Address - Street 1:965 S 100 W
Mailing Address - Street 2:STE. 105
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6062
Mailing Address - Country:US
Mailing Address - Phone:435-752-5522
Mailing Address - Fax:435-752-3075
Practice Address - Street 1:965 S 100 W
Practice Address - Street 2:STE. 105
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-6062
Practice Address - Country:US
Practice Address - Phone:435-752-5522
Practice Address - Fax:435-752-3075
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRYCE J. HUNTER D.C.P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5258533-1202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU96697Medicare UPIN