Provider Demographics
NPI:1801849492
Name:ADVANCED CHIROPRACTIC CARE CENTER, P.C.
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC CARE CENTER, P.C.
Other - Org Name:CHIROPRACTIC & NUTRITION WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:586-731-8840
Mailing Address - Street 1:51735 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-4451
Mailing Address - Country:US
Mailing Address - Phone:586-731-8840
Mailing Address - Fax:586-731-9550
Practice Address - Street 1:51735 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48316-4451
Practice Address - Country:US
Practice Address - Phone:586-731-8840
Practice Address - Fax:586-731-9550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301004819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty