Provider Demographics
NPI:1881866481
Name:ADVANCED CHIROPRACTIC CLINIC, PC
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BRANDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:605-336-3561
Mailing Address - Street 1:5115 S SWIFT PARK DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2655
Mailing Address - Country:US
Mailing Address - Phone:605-336-3561
Mailing Address - Fax:605-339-0265
Practice Address - Street 1:4400 SERGEANT RD
Practice Address - Street 2:SUITE 216
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4740
Practice Address - Country:US
Practice Address - Phone:712-274-6202
Practice Address - Fax:712-274-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007056111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty