Provider Demographics
NPI:1508299587
Name:ADVANCED FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ADVANCED FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:C
Authorized Official - Last Name:PIERSOL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-423-1012
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-0445
Mailing Address - Country:US
Mailing Address - Phone:740-423-1012
Mailing Address - Fax:740-423-8579
Practice Address - Street 1:517 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1617
Practice Address - Country:US
Practice Address - Phone:740-423-1012
Practice Address - Fax:740-423-8579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty