Provider Demographics
NPI:1831560275
Name:ADVANCED HEALTH CHIROPRACTIC
Entity type:Organization
Organization Name:ADVANCED HEALTH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAQUELYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BITLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-395-9132
Mailing Address - Street 1:1147 S WABASH AVE
Mailing Address - Street 2:SUITE 250B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2346
Mailing Address - Country:US
Mailing Address - Phone:312-987-4878
Mailing Address - Fax:312-235-0909
Practice Address - Street 1:1147 S WABASH AVE
Practice Address - Street 2:SUITE 250B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-2346
Practice Address - Country:US
Practice Address - Phone:312-987-4878
Practice Address - Fax:312-235-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty