Provider Demographics
NPI:1760654701
Name:ADVANCED HEALTH AND WELLNESS PLLC
Entity Type:Organization
Organization Name:ADVANCED HEALTH AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-752-5522
Mailing Address - Street 1:965 S 100 W STE 105
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6067
Mailing Address - Country:US
Mailing Address - Phone:435-752-5522
Mailing Address - Fax:435-752-3075
Practice Address - Street 1:965 S 100 W STE 105
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-6067
Practice Address - Country:US
Practice Address - Phone:435-752-5522
Practice Address - Fax:435-752-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty