Provider Demographics
NPI:1437314655
Name:ADVANCED CHIROPRACTIC
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC
Other - Org Name:NATURAL HEALTH & SPINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILLET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-621-0270
Mailing Address - Street 1:1069 STEWART ST # 1
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-1337
Mailing Address - Country:US
Mailing Address - Phone:801-621-0270
Mailing Address - Fax:801-866-0422
Practice Address - Street 1:1069 STEWART ST # 1
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-1337
Practice Address - Country:US
Practice Address - Phone:801-621-0270
Practice Address - Fax:801-866-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1743191202111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000005810Medicare UPIN
UTU4226Medicare UPIN