Provider Demographics
NPI:1255647996
Name:ADVANCED CHIROPRACTIC AND PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:ADVANCED CHIROPRACTIC AND PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-726-7404
Mailing Address - Street 1:PO BOX 3351
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44513-3351
Mailing Address - Country:US
Mailing Address - Phone:330-726-7404
Mailing Address - Fax:330-729-9166
Practice Address - Street 1:755 BOARDMAN CANFIELD RD STE P1
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-7325
Practice Address - Country:US
Practice Address - Phone:330-726-7404
Practice Address - Fax:330-729-9166
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED CHIROPRACTIC & REHAB, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-19
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2826111NR0400X, 111NS0005X
224Y00000X, 225100000X, 225200000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise PhysiologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty