Provider Demographics
NPI:1346252004
Name:ADVANCED CHIROPRACTIC SYSTEMS LLC
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC SYSTEMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-409-9500
Mailing Address - Street 1:113 7TH ST
Mailing Address - Street 2:LUMBERYARD SHOPS
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-1234
Mailing Address - Country:US
Mailing Address - Phone:570-409-9500
Mailing Address - Fax:570-409-9505
Practice Address - Street 1:113 7TH ST
Practice Address - Street 2:LUMBERYARD SHOPS
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-1234
Practice Address - Country:US
Practice Address - Phone:570-409-9500
Practice Address - Fax:570-409-9505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC008926111N00000X
PADC006974-2111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1775454OtherHIGHMARK BLUE SHIELD
PAV03602Medicare UPIN
PA1775454OtherHIGHMARK BLUE SHIELD