Provider Demographics
NPI:1558909853
Name:ADVANCED SPINE & WELLNESS LLC
Entity Type:Organization
Organization Name:ADVANCED SPINE & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FLUITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-200-3910
Mailing Address - Street 1:1101 BUNTON CREEK RD.
Mailing Address - Street 2:STE. 330
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640
Mailing Address - Country:US
Mailing Address - Phone:512-200-3910
Mailing Address - Fax:512-572-8228
Practice Address - Street 1:1101 BUNTON CREEK RD.
Practice Address - Street 2:STE. 330
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640
Practice Address - Country:US
Practice Address - Phone:512-200-3910
Practice Address - Fax:512-572-8228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty