Provider Demographics
NPI:1760650840
Name:ADVANCED CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:763-542-1141
Mailing Address - Street 1:2508 HILLSBORO AVE N
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-3107
Mailing Address - Country:US
Mailing Address - Phone:763-524-1141
Mailing Address - Fax:
Practice Address - Street 1:2508 HILLSBORO AVE N
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-3107
Practice Address - Country:US
Practice Address - Phone:763-542-1141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2804111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty