Provider Demographics
NPI:1851783682
Name:ADVANCED CARE CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:ADVANCED CARE CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THY
Authorized Official - Middle Name:KHANH
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:909-820-2220
Mailing Address - Street 1:1613 S RIVERSIDE AVE
Mailing Address - Street 2:STE. D
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-7701
Mailing Address - Country:US
Mailing Address - Phone:909-820-2220
Mailing Address - Fax:
Practice Address - Street 1:1613 S RIVERSIDE AVE
Practice Address - Street 2:STE. D
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-7701
Practice Address - Country:US
Practice Address - Phone:909-820-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty