Provider Demographics
NPI:1972646404
Name:ADVANTAGE CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:ADVANTAGE CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NANCE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-214-2007
Mailing Address - Street 1:2040 S ALMA SCHOOL RD STE 16
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-2077
Mailing Address - Country:US
Mailing Address - Phone:480-214-2007
Mailing Address - Fax:480-899-8047
Practice Address - Street 1:2040 S ALMA SCHOOL RD STE 16
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-2077
Practice Address - Country:US
Practice Address - Phone:480-214-2007
Practice Address - Fax:480-899-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7662111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ108680Medicare PIN