Provider Demographics
NPI:1386816072
Name:ADVANCED HEALTH CENTER, P.A.
Entity Type:Organization
Organization Name:ADVANCED HEALTH CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:D
Authorized Official - Last Name:KISSINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:785-841-2218
Mailing Address - Street 1:3017 W 6TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-2364
Mailing Address - Country:US
Mailing Address - Phone:785-841-2218
Mailing Address - Fax:
Practice Address - Street 1:3017 W 6TH ST STE A
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66049-2364
Practice Address - Country:US
Practice Address - Phone:785-841-2218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSDN2494OtherRAILROAD MEDICARE
KSDN2494OtherRR MEDICARE
KS660214OtherBLUE CROSS BLUE SHIELD
KSDN2494OtherRR MEDICARE