1992911200 NPI number — ADVANCE CHIROPRACTIC ADJUSTMENT, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992911200 NPI number — ADVANCE CHIROPRACTIC ADJUSTMENT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCE CHIROPRACTIC ADJUSTMENT, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992911200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3643 WIMBLEDON LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAVENPORT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33837-8698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-521-0677
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
280 PATTERSON RD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAINES CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33844-6261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-421-8687
Provider Business Practice Location Address Fax Number:
863-421-8670
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MERCIER
Authorized Official First Name:
ANNE-RUTHE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
863-521-0677

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HCC7316 . This is a "HEALTH CARE CLINIC" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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