Provider Demographics
NPI:1467690560
Name:AAADVANCED CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:AAADVANCED CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:602-995-1295
Mailing Address - Street 1:1830 W COLTER ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-9001
Mailing Address - Country:US
Mailing Address - Phone:602-995-1295
Mailing Address - Fax:602-995-1296
Practice Address - Street 1:1830 W COLTER ST STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-9001
Practice Address - Country:US
Practice Address - Phone:602-995-1295
Practice Address - Fax:602-995-1296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty