Provider Demographics
NPI:1063785418
Name:ADVANCED HEALTHCARE PLLC
Entity type:Organization
Organization Name:ADVANCED HEALTHCARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:870-534-8212
Mailing Address - Street 1:5209 W 65TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-3817
Mailing Address - Country:US
Mailing Address - Phone:870-534-8212
Mailing Address - Fax:870-534-8216
Practice Address - Street 1:5209 W 65TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-3817
Practice Address - Country:US
Practice Address - Phone:870-534-8212
Practice Address - Fax:870-534-8216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1684111N00000X
AR1664111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty