Provider Demographics
NPI:1215357702
Name:AAVANCE CHIROPRACTIC HEALTHCARE LLC
Entity Type:Organization
Organization Name:AAVANCE CHIROPRACTIC HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR ALICE HART DUFFER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:HART
Authorized Official - Last Name:DUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:CHIROPRACTOR
Authorized Official - Phone:832-240-4319
Mailing Address - Street 1:14210 HIGHWAY 3 STE B
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-1603
Mailing Address - Country:US
Mailing Address - Phone:832-240-4319
Mailing Address - Fax:
Practice Address - Street 1:14210 HIGHWAY 3 STE B
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1603
Practice Address - Country:US
Practice Address - Phone:832-240-4319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-23
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12244111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX379131Medicare PIN