Provider Demographics
NPI:1518274562
Name:ADVANCED HOLISTIC CHIROPRACTIC CARE
Entity Type:Organization
Organization Name:ADVANCED HOLISTIC CHIROPRACTIC CARE
Other - Org Name:PAIN MANAGEMENT & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RASHAD
Authorized Official - Middle Name:RENEH
Authorized Official - Last Name:TRABULSI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-596-2448
Mailing Address - Street 1:123 HICKS STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:10304
Mailing Address - Country:US
Mailing Address - Phone:718-596-2448
Mailing Address - Fax:718-596-2441
Practice Address - Street 1:123 HICKS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2304
Practice Address - Country:US
Practice Address - Phone:718-596-2448
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty