Provider Demographics
NPI:1124396718
Name:ADVANCED HEALTHCARE, PLLC
Entity type:Organization
Organization Name:ADVANCED HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:IRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:970-222-7327
Mailing Address - Street 1:2531 S SHIELDS ST STE 2H
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1857
Mailing Address - Country:US
Mailing Address - Phone:970-472-8333
Mailing Address - Fax:970-472-8332
Practice Address - Street 1:2531 S SHIELDS ST STE 2H
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1857
Practice Address - Country:US
Practice Address - Phone:970-472-8333
Practice Address - Fax:970-472-8332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5759111NR0400X
CO49380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty