Provider Demographics
NPI:1952771412
Name:ADVANCED HEALTH CLINIC, LLC.
Entity Type:Organization
Organization Name:ADVANCED HEALTH CLINIC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAPOZHNIKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-353-0015
Mailing Address - Street 1:214 LUNENBURG ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-4589
Mailing Address - Country:US
Mailing Address - Phone:978-353-0015
Mailing Address - Fax:978-353-0014
Practice Address - Street 1:214 LUNENBURG ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-4580
Practice Address - Country:US
Practice Address - Phone:978-353-0015
Practice Address - Fax:978-353-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty