Provider Demographics
NPI:1326285735
Name:ADVANCED ARM DYNAMICS OF THE
Entity Type:Organization
Organization Name:ADVANCED ARM DYNAMICS OF THE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGUELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CP, FAAOP,
Authorized Official - Phone:310-372-3050
Mailing Address - Street 1:527 PARK LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5236
Mailing Address - Country:US
Mailing Address - Phone:319-234-0196
Mailing Address - Fax:319-236-4425
Practice Address - Street 1:527 PARK LN
Practice Address - Street 2:SUITE 500
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5236
Practice Address - Country:US
Practice Address - Phone:319-234-0196
Practice Address - Fax:319-236-4425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA107035980335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP001751OtherAMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS PROSTHETICS & PEDORTHICS (ABC)
CP002760OtherAMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS PROSTHETICS PEDORTHICS (ABC)
CACP001751OtherAMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS PROSTHETICS & PEDORTHICS (ABC)