Provider Demographics
NPI:1710002159
Name:ADVANCED HEALTH AND CHIROPRACTIC CENTER, PLLC
Entity Type:Organization
Organization Name:ADVANCED HEALTH AND CHIROPRACTIC CENTER, PLLC
Other - Org Name:CHIROPRACTIC SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-664-4000
Mailing Address - Street 1:191A W PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-6806
Mailing Address - Country:US
Mailing Address - Phone:704-664-4000
Mailing Address - Fax:704-660-5251
Practice Address - Street 1:191A W PLAZA DR
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117
Practice Address - Country:US
Practice Address - Phone:704-664-4000
Practice Address - Fax:704-660-5251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2900111N00000X
NC17659225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908609Medicaid