Provider Demographics
NPI:1316239437
Name:ADVANCED HEALTHCARE CENTER LLC
Entity type:Organization
Organization Name:ADVANCED HEALTHCARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:SALAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-670-5975
Mailing Address - Street 1:2274 KRESGE DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1260
Mailing Address - Country:US
Mailing Address - Phone:440-670-5975
Mailing Address - Fax:440-210-6444
Practice Address - Street 1:2271 COOPER FOSTER PARK RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-1267
Practice Address - Country:US
Practice Address - Phone:440-670-5975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-08
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1710111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty