Provider Demographics
NPI:1760710453
Name:ADVANCED CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:JANUSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-778-0147
Mailing Address - Street 1:728 N MONTEZUMA ST STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-2090
Mailing Address - Country:US
Mailing Address - Phone:928-778-0147
Mailing Address - Fax:928-778-0772
Practice Address - Street 1:728 N MONTEZUMA ST STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2090
Practice Address - Country:US
Practice Address - Phone:928-778-0147
Practice Address - Fax:928-778-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0749111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1467400879OtherINDIVIDUAL PIN