Provider Demographics
NPI:1245415546
Name:ADVANCED CHIROPRACTIC CTR
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER BILLING SERVICE
Authorized Official - Prefix:MS
Authorized Official - First Name:FELICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-504-0595
Mailing Address - Street 1:340 RANCHEROS DR
Mailing Address - Street 2:STE 190
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2900
Mailing Address - Country:US
Mailing Address - Phone:760-744-2744
Mailing Address - Fax:760-744-2798
Practice Address - Street 1:340 RANCHEROS DR
Practice Address - Street 2:STE 190
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2900
Practice Address - Country:US
Practice Address - Phone:760-744-2744
Practice Address - Fax:760-744-2798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25170111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty