Provider Demographics
NPI:1417409061
Name:ADVANCED ACCIDENT CARE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ADVANCED ACCIDENT CARE CHIROPRACTIC LLC
Other - Org Name:NORTHWEST CHIROPRACTIC CARE OF SHERWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:O
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-261-1340
Mailing Address - Street 1:16771 SW 12TH ST. SUITE E
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-6024
Mailing Address - Country:US
Mailing Address - Phone:503-822-5242
Mailing Address - Fax:503-822-5293
Practice Address - Street 1:16771 SW 12TH ST. SUITE E
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-6024
Practice Address - Country:US
Practice Address - Phone:503-822-5242
Practice Address - Fax:503-822-5293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-31
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4922111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty