Provider Demographics
NPI:1396460192
Name:ADVANCED FUNCTIONAL CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:ADVANCED FUNCTIONAL CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:ARSENAULT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-708-6643
Mailing Address - Street 1:34305 SOLON RD STE 30
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-2660
Mailing Address - Country:US
Mailing Address - Phone:814-242-1024
Mailing Address - Fax:
Practice Address - Street 1:34305 SOLON RD STE 30
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2660
Practice Address - Country:US
Practice Address - Phone:814-242-1024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty