Provider Demographics
NPI:1801459581
Name:ADVANCED ORTHOPEDIC & CHIROPRACTIC L.L.C.
Entity type:Organization
Organization Name:ADVANCED ORTHOPEDIC & CHIROPRACTIC L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:307-682-7885
Mailing Address - Street 1:201 W LAKEWAY RD STE 211
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6341
Mailing Address - Country:US
Mailing Address - Phone:307-682-7885
Mailing Address - Fax:307-682-2153
Practice Address - Street 1:201 W LAKEWAY RD STE 211
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6341
Practice Address - Country:US
Practice Address - Phone:307-682-7885
Practice Address - Fax:307-682-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty