Provider Demographics
NPI:1275815284
Name:ADVANCED ORTHOGONAL CHIROPRACTIC,LLC
Entity Type:Organization
Organization Name:ADVANCED ORTHOGONAL CHIROPRACTIC,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTAL
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-682-7885
Mailing Address - Street 1:105 W LAKEWAY RD
Mailing Address - Street 2:UNIT C
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6369
Mailing Address - Country:US
Mailing Address - Phone:307-682-7885
Mailing Address - Fax:307-682-2153
Practice Address - Street 1:105 W LAKEWAY RD
Practice Address - Street 2:UNIT C
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6369
Practice Address - Country:US
Practice Address - Phone:307-682-7885
Practice Address - Fax:307-682-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY674111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty