Provider Demographics
NPI:1619915618
Name:ADVANCED CARE CHIROPRACTIC
Entity Type:Organization
Organization Name:ADVANCED CARE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:DELSIGNORE
Authorized Official - Suffix:
Authorized Official - Credentials:CH
Authorized Official - Phone:410-760-7722
Mailing Address - Street 1:7954 BALTIMORE ANNAPOLIS BLVD
Mailing Address - Street 2:SUITE2K
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-8188
Mailing Address - Country:US
Mailing Address - Phone:410-760-7722
Mailing Address - Fax:
Practice Address - Street 1:7954 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:SUITE 2K
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-8188
Practice Address - Country:US
Practice Address - Phone:410-760-7722
Practice Address - Fax:410-760-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03459111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD282PMedicare PIN