Provider Demographics
NPI:1215033311
Name:ADVANCED SPINE AND HEADACHE CENTER
Entity Type:Organization
Organization Name:ADVANCED SPINE AND HEADACHE CENTER
Other - Org Name:ALEX MELTSER, D.C.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTSER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:248-356-2100
Mailing Address - Street 1:21751 W 11 MILE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-3712
Mailing Address - Country:US
Mailing Address - Phone:248-356-2100
Mailing Address - Fax:248-356-2121
Practice Address - Street 1:21751 W 11 MILE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3712
Practice Address - Country:US
Practice Address - Phone:248-356-2100
Practice Address - Fax:248-356-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty