Provider Demographics
NPI:1275554164
Name:ADVANCED HEALTH CHIROPRACTIC CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED HEALTH CHIROPRACTIC CENTER, LLC
Other - Org Name:ROBERT GOLDERG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROMANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-387-2455
Mailing Address - Street 1:2545 MOSSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3520
Mailing Address - Country:US
Mailing Address - Phone:724-387-2455
Mailing Address - Fax:724-387-2456
Practice Address - Street 1:1717 GOLDEN MILE HWY
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2011
Practice Address - Country:US
Practice Address - Phone:724-327-2072
Practice Address - Fax:724-327-2074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007714L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1766870OtherBLUES
PA=========OtherCOMMERCIAL