Provider Demographics
NPI:1467646612
Name:ADVANCED MULTI-CARE PHYSICIANS GROUP
Entity Type:Organization
Organization Name:ADVANCED MULTI-CARE PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:630-759-8989
Mailing Address - Street 1:440 W BOUGHTON RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1892
Mailing Address - Country:US
Mailing Address - Phone:630-759-8989
Mailing Address - Fax:630-759-8973
Practice Address - Street 1:440 W BOUGHTON RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1892
Practice Address - Country:US
Practice Address - Phone:630-759-8989
Practice Address - Fax:630-759-8973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL038-008009111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty