Provider Demographics
NPI:1851585301
Name:ADVANCED SPINE AND PAIN MANAGEMENT INC.
Entity Type:Organization
Organization Name:ADVANCED SPINE AND PAIN MANAGEMENT INC.
Other - Org Name:SANGHA CHIROPRACTIC AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAIMAL
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:SANGHA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:559-704-9698
Mailing Address - Street 1:4105 W SWIFT AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-6385
Mailing Address - Country:US
Mailing Address - Phone:559-704-9698
Mailing Address - Fax:209-725-8373
Practice Address - Street 1:4105 W SWIFT AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-6385
Practice Address - Country:US
Practice Address - Phone:559-704-9698
Practice Address - Fax:209-725-8373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29149111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty