Provider Demographics
NPI:1669610424
Name:ADVANCED SPINAL CARE, LLC
Entity type:Organization
Organization Name:ADVANCED SPINAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-822-2227
Mailing Address - Street 1:PO BOX 862
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-0862
Mailing Address - Country:US
Mailing Address - Phone:808-822-2227
Mailing Address - Fax:
Practice Address - Street 1:4-1345 KUHIO HWY STE D
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1600
Practice Address - Country:US
Practice Address - Phone:808-822-2227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDC-1107111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIBL755AMedicare PIN