Provider Demographics
NPI:1528242930
Name:ADVANCE CHIROPRACTIC PC
Entity type:Organization
Organization Name:ADVANCE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-753-1191
Mailing Address - Street 1:4050 W RAY RD STE 18
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-7256
Mailing Address - Country:US
Mailing Address - Phone:480-897-0330
Mailing Address - Fax:480-897-0660
Practice Address - Street 1:4050 W RAY RD STE 18
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-7256
Practice Address - Country:US
Practice Address - Phone:480-897-0330
Practice Address - Fax:480-897-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU40536Medicare UPIN