Provider Demographics
NPI:1922011055
Name:ADVANCED HEALTH CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:ADVANCED HEALTH CHIROPRACTIC, INC
Other - Org Name:CLAYCOMO CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GOLLADAY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:816-453-1198
Mailing Address - Street 1:244 E US HIGHWAY 69
Mailing Address - Street 2:#202
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64119-3115
Mailing Address - Country:US
Mailing Address - Phone:816-453-1198
Mailing Address - Fax:816-479-2933
Practice Address - Street 1:244 E US HIGHWAY 69
Practice Address - Street 2:#202
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64119-3115
Practice Address - Country:US
Practice Address - Phone:816-453-1198
Practice Address - Fax:816-479-2933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006012466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty