Provider Demographics
NPI:1972529196
Name:ADVANCED HEALTHCARE PC
Entity type:Organization
Organization Name:ADVANCED HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:POULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-795-1700
Mailing Address - Street 1:9194 W GOLF RD
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-5806
Mailing Address - Country:US
Mailing Address - Phone:847-795-1700
Mailing Address - Fax:847-795-1750
Practice Address - Street 1:9194 W GOLF RD
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-5806
Practice Address - Country:US
Practice Address - Phone:847-795-1700
Practice Address - Fax:847-795-1750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1630049OtherBLUE CROSS/BLUE SHIELD
IL795920Medicare ID - Type UnspecifiedMEDICARE
ILL87123Medicare UPIN