Provider Demographics
NPI:1407014822
Name:ADVANCE CHIROPRACTIC CLINIC P.C.
Entity Type:Organization
Organization Name:ADVANCE CHIROPRACTIC CLINIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:COONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-278-0363
Mailing Address - Street 1:6401 DOUGLAS AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-3350
Mailing Address - Country:US
Mailing Address - Phone:515-278-0363
Mailing Address - Fax:515-278-0445
Practice Address - Street 1:6401 DOUGLAS AVE STE 12
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-3350
Practice Address - Country:US
Practice Address - Phone:515-278-0363
Practice Address - Fax:515-278-0445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06368111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty