Provider Demographics
NPI:1619157476
Name:ADVANCE CHIROPRACTIC ADJUSTMENT
Entity Type:Organization
Organization Name:ADVANCE CHIROPRACTIC ADJUSTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARLENE
Authorized Official - Last Name:LUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-421-8687
Mailing Address - Street 1:280 PATTERSON RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-6261
Mailing Address - Country:US
Mailing Address - Phone:863-421-8687
Mailing Address - Fax:863-421-8670
Practice Address - Street 1:280 PATTERSON RD
Practice Address - Street 2:SUITE #2
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-6261
Practice Address - Country:US
Practice Address - Phone:863-421-8687
Practice Address - Fax:863-421-8670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7872111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty