Provider Demographics
NPI:1104930650
Name:ADVANCED CHIROPRACTIC & WELLNESS CENTER, INC
Entity type:Organization
Organization Name:ADVANCED CHIROPRACTIC & WELLNESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-878-5991
Mailing Address - Street 1:PO BOX 5325
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85312-5325
Mailing Address - Country:US
Mailing Address - Phone:623-334-9200
Mailing Address - Fax:
Practice Address - Street 1:5730 W PEORIA AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-1423
Practice Address - Country:US
Practice Address - Phone:623-878-5991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ 6018111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0939570OtherBCBS OF AZ
AZAZ0939570OtherBCBS OF AZ
AZU81942Medicare UPIN