1619471109 NPI number — ADVANCED MOTION CHIROPRACTIC PLLC

Table of content: MARTIN JOSEPH HERMAN M.D. (NPI 1710924030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619471109 NPI number — ADVANCED MOTION CHIROPRACTIC PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED MOTION CHIROPRACTIC PLLC
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:
1619471109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6824 E BROWN RD # 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85207-3705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-454-3418
Provider Business Mailing Address Fax Number:
480-466-3081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6824 E BROWN RD # 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85207-3705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-454-3418
Provider Business Practice Location Address Fax Number:
480-466-3081
Provider Enumeration Date:
03/20/2018

Additional Information

Authorized Official

Authorized Official Last Name:
ADAIR
Authorized Official First Name:
TYSON
Authorized Official Middle Name:
C
Authorized Official Title or Position:
SOLE OWNER
Authorized Official Telephone Number:
480-454-3418

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  8409 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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