Provider Demographics
NPI:1245412972
Name:ADVANCED CHIROPRACTIC INC
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RATKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-535-9600
Mailing Address - Street 1:3425 EXECUTIVE PKY.
Mailing Address - Street 2:STE. 120
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1333
Mailing Address - Country:US
Mailing Address - Phone:419-535-9600
Mailing Address - Fax:419-535-3891
Practice Address - Street 1:3425 EXECUTIVE PKY
Practice Address - Street 2:STE 120
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1333
Practice Address - Country:US
Practice Address - Phone:419-535-9600
Practice Address - Fax:419-535-3891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1058111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4534135OtherAETNA
OH0719851Medicaid
OH000000136442OtherANTHEM BCBS
OH01538OtherPARAMOUNT HEATLTHCARE
OH=========-005OtherMEDICAL MUTUAL OF OHIO
OH=========-005OtherMEDICAL MUTUAL OF OHIO