Provider Demographics
NPI:1578615357
Name:ADVANCED CHIROPRACTIC ASSOCIATES PA
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC ASSOCIATES PA
Other - Org Name:ADVANCED PHYSICAL THERAPY & CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-753-1111
Mailing Address - Street 1:429 WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004-2227
Mailing Address - Country:US
Mailing Address - Phone:856-753-1111
Mailing Address - Fax:
Practice Address - Street 1:429 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:ATCO
Practice Address - State:NJ
Practice Address - Zip Code:08004-2227
Practice Address - Country:US
Practice Address - Phone:856-753-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ597939Medicare ID - Type UnspecifiedGROUP ID