Provider Demographics
NPI:1265732812
Name:ADVANCED NEURO DIAGNOSTICS
Entity type:Organization
Organization Name:ADVANCED NEURO DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:E
Authorized Official - Last Name:ZERKLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:304-416-2888
Mailing Address - Street 1:P.O. BOX 114
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45174
Mailing Address - Country:US
Mailing Address - Phone:304-416-2888
Mailing Address - Fax:
Practice Address - Street 1:100 TOWNSHIP ROAD 1245
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669
Practice Address - Country:US
Practice Address - Phone:304-416-2888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1531111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty