Provider Demographics
NPI:1457409831
Name:ADVANCED MEDICAL SPECIALTIES GROUP, SC
Entity Type:Organization
Organization Name:ADVANCED MEDICAL SPECIALTIES GROUP, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DYER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:815-544-3894
Mailing Address - Street 1:887 WHITE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-9057
Mailing Address - Country:US
Mailing Address - Phone:815-544-3894
Mailing Address - Fax:
Practice Address - Street 1:860 BIESTER DR
Practice Address - Street 2:STE 103
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-4053
Practice Address - Country:US
Practice Address - Phone:815-544-3894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED MEDICAL SPECIALTIES GROUP, SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-08
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherTAX ID