Provider Demographics
NPI:1235588914
Name:ADVANCED CHIROPRACTIC HEALTH CENTER
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KINAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HADAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:661-947-2455
Mailing Address - Street 1:615 W AVENUE Q STE E
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3887
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 W AVENUE Q STE E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3887
Practice Address - Country:US
Practice Address - Phone:661-947-2455
Practice Address - Fax:661-947-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty