Provider Demographics
NPI:1366824369
Name:ADVANCED CHIROPRACTIC HEALTH CENTRE, LLC
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC HEALTH CENTRE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MOUNSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-636-6300
Mailing Address - Street 1:2235 S HWY 89 STE B7
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-9208
Mailing Address - Country:US
Mailing Address - Phone:928-636-6300
Mailing Address - Fax:928-350-8911
Practice Address - Street 1:2235 S HWY 89 STE B7
Practice Address - Street 2:
Practice Address - City:CHINO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86323
Practice Address - Country:US
Practice Address - Phone:928-636-6300
Practice Address - Fax:928-350-8911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-25
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8384111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty