Provider Demographics
NPI:1124995410
Name:ADVANCED SPINE & REHABILITATION
Entity type:Organization
Organization Name:ADVANCED SPINE & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:702-990-2225
Mailing Address - Street 1:2168 W GROVE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-6748
Mailing Address - Country:US
Mailing Address - Phone:702-990-2225
Mailing Address - Fax:702-990-7711
Practice Address - Street 1:715 MALL RING CIR STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6666
Practice Address - Country:US
Practice Address - Phone:702-990-2225
Practice Address - Fax:702-990-7711
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST CARE MEDICAL-JONATHAN GUENTER MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-10-21
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty