Provider Demographics
NPI:1619029436
Name:ADVANCED HEALTH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ADVANCED HEALTH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEROTTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:775-746-8555
Mailing Address - Street 1:9570 S MCCARRAN BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-9201
Mailing Address - Country:US
Mailing Address - Phone:775-746-2555
Mailing Address - Fax:775-746-2566
Practice Address - Street 1:9570 S MCCARRAN BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-9201
Practice Address - Country:US
Practice Address - Phone:775-746-2555
Practice Address - Fax:775-746-2566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1619029436Medicare PIN