Provider Demographics
NPI:1578626370
Name:ADVANCED CHIROPRACTIC PC
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-388-0406
Mailing Address - Street 1:1122 JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-4335
Mailing Address - Country:US
Mailing Address - Phone:605-388-0406
Mailing Address - Fax:605-718-1211
Practice Address - Street 1:1122 JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-4335
Practice Address - Country:US
Practice Address - Phone:605-388-0406
Practice Address - Fax:605-718-1211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD949111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty