Provider Demographics
NPI:1316395833
Name:ADVANCED CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC CENTER
Other - Org Name:ASHEVILLE FUNCTIONAL NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WALICKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:828-667-8000
Mailing Address - Street 1:22 SARDIS RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-8536
Mailing Address - Country:US
Mailing Address - Phone:828-667-8000
Mailing Address - Fax:828-667-8001
Practice Address - Street 1:22 SARDIS RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-8536
Practice Address - Country:US
Practice Address - Phone:828-667-8000
Practice Address - Fax:828-667-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3320012111N00000X
NC2348111NN0400X, 111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC100830373OtherNPI