Provider Demographics
NPI:1932312048
Name:ADVANCED ALTERNATIVE SPINAL CARE LLC
Entity Type:Organization
Organization Name:ADVANCED ALTERNATIVE SPINAL CARE LLC
Other - Org Name:BACK PAIN SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:EGSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:972-393-3737
Mailing Address - Street 1:809 S MACARTHUR BLVD
Mailing Address - Street 2:400
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4260
Mailing Address - Country:US
Mailing Address - Phone:972-393-3737
Mailing Address - Fax:972-393-4925
Practice Address - Street 1:809 S MACARTHUR BLVD
Practice Address - Street 2:400
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4260
Practice Address - Country:US
Practice Address - Phone:972-393-3737
Practice Address - Fax:972-393-4925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty