Provider Demographics
NPI:1124449624
Name:ADVANCED HEALTH CHIROPRACTIC
Entity type:Organization
Organization Name:ADVANCED HEALTH CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:P
Authorized Official - Last Name:KHOURY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:925-373-6363
Mailing Address - Street 1:1150 MURRIETA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4113
Mailing Address - Country:US
Mailing Address - Phone:925-373-6363
Mailing Address - Fax:925-373-6682
Practice Address - Street 1:1150 MURRIETA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4113
Practice Address - Country:US
Practice Address - Phone:925-373-6363
Practice Address - Fax:925-373-6682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21021261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center