Provider Demographics
NPI:1447591367
Name:ADVANCED CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:NOERENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-695-0220
Mailing Address - Street 1:953 N LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-3061
Mailing Address - Country:US
Mailing Address - Phone:847-695-0220
Mailing Address - Fax:
Practice Address - Street 1:953 N LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-3061
Practice Address - Country:US
Practice Address - Phone:847-695-0220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038006220111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty