Provider Demographics
NPI:1831344472
Name:ADVANCED FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:ADVANCED FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:607-936-7871
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:219 W MAIN ST
Mailing Address - City:MONTOUR FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14865
Mailing Address - Country:US
Mailing Address - Phone:607-535-7080
Mailing Address - Fax:
Practice Address - Street 1:219 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTOUR FALLS
Practice Address - State:NY
Practice Address - Zip Code:14865
Practice Address - Country:US
Practice Address - Phone:607-535-7080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANDS ON CHIROPRACTIC PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008606-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1386717635OtherNPI
NY1821267105OtherHANDS ON CHIROPRACTIC PLLC
RB8554Medicare UPIN
NY1821267105OtherHANDS ON CHIROPRACTIC PLLC