Provider Demographics
NPI:1891919601
Name:ADVANCED FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ADVANCED FAMILY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:MEACHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:636-327-3333
Mailing Address - Street 1:1023 MAIN PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-1170
Mailing Address - Country:US
Mailing Address - Phone:636-327-3333
Mailing Address - Fax:636-639-8922
Practice Address - Street 1:1023 MAIN PLAZA DR
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1170
Practice Address - Country:US
Practice Address - Phone:636-327-3333
Practice Address - Fax:636-639-8922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004730111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty