Provider Demographics
NPI:1225104573
Name:ADVANTAGE CHIROPRACTIC CLINIC, PC
Entity Type:Organization
Organization Name:ADVANTAGE CHIROPRACTIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:334-821-2552
Mailing Address - Street 1:2408 E UNIVERSITY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-9403
Mailing Address - Country:US
Mailing Address - Phone:334-821-2552
Mailing Address - Fax:866-850-0983
Practice Address - Street 1:2408 E UNIVERSITY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-9403
Practice Address - Country:US
Practice Address - Phone:334-821-2552
Practice Address - Fax:866-850-0983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL423253114111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALV11631Medicare UPIN
AL051539189Medicare PIN
ALV11686Medicare UPIN
AL051558576Medicare PIN