Provider Demographics
NPI:1063900546
Name:ADVANCED CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:ADVANCED CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHOEMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:907-374-0718
Mailing Address - Street 1:1901 AIRPORT WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4049
Mailing Address - Country:US
Mailing Address - Phone:907-374-0718
Mailing Address - Fax:907-374-0719
Practice Address - Street 1:1901 AIRPORT WAY STE 102
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4049
Practice Address - Country:US
Practice Address - Phone:907-374-0718
Practice Address - Fax:907-374-0719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK118490111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty